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AHCIP business forms
Facility Registration form AHC0910A – application to register facilities and professionals providing services under the Alberta Health Care Insurance Plan (AHCIP)
- Instructions for Facility Registration form (PDF, 302 KB)
The updated version includes additional information about accreditation letters.
Practitioner/Allied Practitioners Information form AHC11234 – application to register practitioners/allied practitioners and professional corporations providing services under the AHCIP
Physician Skill Validation form AHC13188 – application to validate physician skills providing services under the AHCIP
Business Arrangement and Relationships Application form AHC11236 – application to register or make changes to a business arrangement providing services under the AHCIP, or to attach an accredited submitter to a business arrangement, as well as any additional providers
Business Address Change form AHC11459 – application to update your business address
Direct Deposit Request AHC1143 – application to redirect the deposit of claims on an existing business arrangement
Request for Statement of Assessment / Account AHC0002 – application for online request of statements of Accounts and Assessments
Patient Information Update form AHC2148 (PDF, 1.0 MB) – for patients who have a change or correction to their name, date of birth, or address
Reciprocal billing
Hospital Reciprocal Claims Guide
Valid Canada Health Care Cards (PDF, 2.8 MB) – 11x17 poster showing samples of valid health care cards from each province and territory
Hospital Reciprocal Outpatient Services Claim form AHC0216B
Hospital Reciprocal In-Patient Services Claim form AHC0471
Declaration of Hospital Insurance Coverage form AHC0472
Summary Statement Hospital In-Patient Charges form AHC0483
Summary Statement Hospital Outpatient Charges form AHC0562
Quebec Claim for Physician / Practitioner Services form (PDF, 106 KB) – used by Alberta physicians and other practitioners providing services to residents from Quebec
- Complete form and send to:
Régie de l'assurance maladie
Case postale 500
Québec (Québec) G1K 7B4
Resources
- Alberta Drug Benefit List
- Alberta Netcare Electronic Health Record
- Annual Care Plan template (PDF, 284 KB)
- Clinical Practice Guidelines, Toward Optimized Practice
- Guidelines for the Investigation of Clusters of Non-Communicable Health Events
- Health Professions Act – Overview for health care professionals
- Immunization and routine immunization schedule
- Influenza information and surveillance data
- Seasonal Influenza Summary Reports
- Provincial Laboratory for Public Health – Guide to Services
- Provincial Registration Standards and Practices Manual
- Psychosocial Interventions: An Interpretive Guide to the Restricted Activity
- Respiratory virus surveillance interactive data
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