Doctor's Name: Date:
Patient's Name:
Uninsured Fee Code Amount
Forms
A00060 $50.90
A94523
$87.90
A00069
$173.00
A00059
$227.00
A00069
$173.00
A00059
$227.00
A00063
$177.00
A94529
$197.00
Reports/ Letters
A00060
$50.90
A00060
$50.90
A00061
$173.00
A00070
$197.00
A00070
$197.00
A00071
$417.00
A00071
$417.00
A00072
$1,244.00
A00073
$2,082.00
Examinations
A00068 $86.00
A00002 $173.00
A00001 $245.00
A00055 $238.00
$238.00
$238.00
$297.60
$193.00
Procedures & Immunizations (Multiple services will be charged additionally)
$106.15
$211.60
$251.60
$308.60
$40.70
$113.90
$104.90
Other
A00093 $41.60
A00095 $117.00
A00096 $2.10
A00096 $0.30
$89.70
TOTAL
Transfer of Records - photocopying - per page (first 10)
Transfer of Records - photocopying - per page (subsequent pages)
Missed Appointment Charge
Immunizations for individuals 19 years or older, per injection
Immunizations for individuals less than 2 years of age
Immunizations for individuals 2-18 years of age
Transfer of Records - basic fee
Physician Review of Records for medical/legal purposes or transfer of records (per 15 mins)
Industrial First Aid - limited exam
Liquid Nitrogen
Excision (no sutures)
Excision (with sutures)
Insurance and Industrial Examination, including CPP, pilots and air traffic controllers
Excision (with sutures) - facial
Diabetic Driver Report - stand alone (no Driver’s Medical Examination Report)
Complete physical examination (not covered for asymptomatic/healthy persons), age 2-49
Driver’s Medical Examination Report (Blue Stripe Form)
Driver’s license examination – full exam (Yellow Stripe Form)
Diabetic Driver Report in addition to Driver's Medical Examination Report – combined fee
Physical fitness examination and form for school, camp, etc
Insurance Company letter - long (1 - 2 pages)
Medical - legal letter
Medical - legal opinion
Medical - legal report
INVOICE
Fee values effective April 1, 2023
Description
Income Tax Disability - short form
Income Tax Disability - long form
This invoice is for services not covered by the Medical Services Commission Fee-For-Service Payment Schedule.
Fees reflect current Doctors of BC rates for uninsured services. Individual physician rates may vary.
Notes:
Brief letter/note, including insurance note for physiotherapy/massage therapy
Insurance Company letter - short (½ page)
Long Term Care Registration / Administration
Employer's Occupational Fitness Assessment form – extra to examination
Medical Certificate of Death
Medical Advice by letter
Medical leave or off work letter
Brief certificate/form, including school/work time off, medical certificate for government employment
insurance, SPARC-BC parking application, HandyDART & HandyCard application
Special Authority Form - billable only when requested by 3rd party insurer
Insurance Company short form - disability/travel/time off
Insurance Company long form- disability/travel/time off
