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AHCIP business forms

Facility Registration form AHC0910A (PDF, 1.9 MB) – application to register facilities and professionals providing services under the Alberta Health Care Insurance Plan (AHCIP)

Practitioner/Allied Practitioners Information form AHC11234 (PDF, 209 KB) – application to register practitioners/allied practitioners and professional corporations providing services under the AHCIP

Business Arrangement and Relationships Application form AHC11236 (PDF, 226 KB) – 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 (PDF, 113 KB) – application to update your business address

Direct Deposit Request AHC1143 (PDF, 118 KB) – application to redirect the deposit of claims on an existing business arrangement

Request for Statement of Assessment / Account AHC0002 (PDF, 135 KB) – 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, 912 KB) – poster showing samples of valid health care cards from each province and territory

Hospital Reciprocal Outpatient Services Claim form AHC0216B (PDF, 218 KB)

Hospital Reciprocal In-Patient Services Claim form AHC0471 (PDF, 147 KB)

Declaration of Hospital Insurance Coverage form AHC0472 (PDF, 242 KB)

Summary Statement Hospital In-Patient Charges form AHC0483 (PDF, 112 KB)

Summary Statement Hospital Outpatient Charges form AHC0562 (PDF, 134 KB)

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