|Classification / Identification:|
| ||Form Number:||014-0000-80||Edition date: ||2003/10 |
| ||Title:||Out of Province Claim for Physician Services|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||ADM - Negotiations and Accountability Management|| || |
| ||Program:||ADM - Negotiations and Accountability Management|| || |
| ||Purpose of Form:||Under Interprovincial agreement, for travel within Canada, patients/physicians submit form to get reimbursed by applicable health plan.|| || |
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