What the UIIP pharmacy form asks for — and how to autofill 014-4455-64 with my-id.ca
Enroll or report as a UIIP pharmacy without retyping pharmacy and pharmacist details
Pharmacies participating in the Universal Influenza Immunization Program repeat pharmacy legal name, address, licence number, pharmacist-in-charge contact, and delivery information on every seasonal pharmacy form. 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: Vaccines and immunization — ontario.ca
- Form (Central Forms Repository): Universal Influenza Immunization Program Pharmacy Form — 014-4455-64
What this form is about
Form 014-4455-64 is the Universal Influenza Immunization Program Pharmacy Form, used by participating pharmacies to enroll, order, or report under the publicly funded influenza immunization program for pharmacies — confirm seasonal requirements on ontario.ca.
Before you start: what to gather
- Pharmacy legal name and address.
- Ontario pharmacy licence number and corporation number if applicable.
- Pharmacist-in-charge name, registration, and contact.
- Vaccine order or reporting details for the season — confirm on ontario.ca.
Confirm the current process on ontario.ca.
How my-id.ca makes it faster
- Save it once. Store your pharmacy name, address, and pharmacist contact 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
- Who completes this form?
- Participating pharmacies and their pharmacist-in-charge — confirm enrollment on ontario.ca.
- How does my-id.ca help?
- It autofills pharmacy names, addresses, and licence contacts across immunization program forms.
- Is reimbursement on a separate form?
- Yes — pharmacies often also file form 014-4372-64 for UIIP reimbursement.
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.