What a hospital chronic care co-payment form asks for — and how to autofill 014-3264-54 with my-id.ca
Process chronic care co-payments without retyping patient and hospital details
Hospital chronic care co-payment forms repeat the patient's name, health number, attending physician details, and hospital contact information when meals and accommodation charges apply. This guide is an example of storing them once in my-id.ca.
Official form and source
Start from the official source and always use the current version — form numbers and links can change:
- Service page: Hospital chronic care co-payment — ontario.ca
- Form (Central Forms Repository): Hospital Chronic Care Co-payment Form — 014-3264-54
What this form is about
Form 014-3264-54 is the Hospital Chronic Care Co-payment Form used when a designated hospital charges a co-payment for chronic care patients who are more or less permanently resident.
Before you start: what to gather
- Patient full legal name and health number.
- Hospital name, address, and billing contact.
- Attending physician name and determination date.
- Co-payment start date — confirm rules on ontario.ca.
Confirm the current process on ontario.ca.
How my-id.ca makes it faster
- Save it once. Store your patient name and hospital contact details in your my-id.ca profile.
- Keep documents ready. Upload supporting documents to my-id.ca Files so you are not searching at form time.
- Autofill the form. Use the my-id.ca Chrome extension on a web form, or fill a PDF from your saved profile inside my-id.ca.
- Review and submit yourself through the official channel.
Why do it in my-id.ca
Related Ontario forms repeat the same personal details. Captured once in my-id.ca — stored in Canada, with AI on its own servers — every form starts mostly complete.
Frequently asked questions
- When does a co-payment apply?
- When an attending physician determines the patient requires chronic care and is more or less permanently resident — confirm on ontario.ca.
- How does my-id.ca help?
- It autofills patient health numbers and hospital contact details across inpatient administrative forms.
- Do amounts go on this form?
- Confirm current co-payment rates and calculation rules on ontario.ca rather than hard-coding amounts in your records.
Fill it once. Reuse it everywhere.
Save your information in my-id.ca once, then autofill this form and the next one — web forms with the Chrome extension, PDFs right in the app. Your data is stored in Canada and AI runs on my-id.ca's own servers, never sent to third-party AI providers.