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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)

​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


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