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Antenatal Assessment Forms Ontario document sample
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Service Code Service Description
A001A Minor assessment FP
A002A 18 Month Well Baby Check FP
A003A General Assessment FP
A004A General Re-assessment FP
A005A Consultation FP
A006A Repeat consultation FP
A007A Intermediate Assessment FP/PA
A008A Mini assessment FP
A009A Oculo-Visual Assessment FP
A013A Specific assessment ANAES
A014A Partial assessment ANAES
A026A Repeat consultation DERM
A045A Consultation NEUROSURG
A055A Consultation MEDICINE
A073A General Assessment GERIATRICS
A110A Visual Assess - 9 years and under FP
A123A Additional Diagnosis
A193A Specific Assessment PSYCH
A195A Consultation PSYCH
A200A Arranging for Services
A221A Genetic Minor Assessment
A263A General Assessment PAEDIATRICS
A264A General Re-Assessment PAEDIATRICS
A265A Consultation PAEDIATRICS
A283A Medical Specific Assessment LAB MED
A284A Partial Assessment LAB MED
A901A Housecall Assess* -1st seen FP
A903A Predental/preoperative G asses FP
B910A Special Visit Daytime Mon-Fri 1st Pt Seen Off/Hosp/Emerg
C002A Subseq.Visit-UpTo5WeekPerVisitFP
C100A Case Conference
C500A Consultation - other internal
C510A Consultation MD - verbal
C520A Consultation MD - written
C600A Consultation - other external
C813A Midwife-Requested Emergency Assessment FP
C815A MidwifeEmergeAsse: SeeGeneralPreamble FP
D200A Discussion re: treat/serv for diagn/test
D230A Dressing/Packing
E077A Optometry Referral
E120A Smoking Cessation Counselling
E130A Sexual Health Counselling
E200A Contraception and Counselling
E570A WoundCareExcForBody/PercuDiscec Levels++
E700A Healthy Lifestyle
E999A Form Completion
F001A Fitness Evaluation
G001A Cholesterol, total LAB MEDICINE
G002A Glucose, LAB MEDICINE
G004A Occult blood test LAB MEDICINE
G005A Pregnancy Test LAB MEDICINE
G006A SGOT LAB MEDICINE
G007A Urea nitrogen (B.U.N.) LAB MEDICINE
G009A Urinalysis without office call LAB MEDICINE
G010A Urinalysis, routine - in the office LAB MEDICINE
G011A FungusCulture including KOH preparation LAB MEDICINE
G012A Wet preparation(for fungus, etc) LAB MEDICINE
G014A Rapid streptococcal test LAB MEDICINE
G150A VisualEvokedResponse-Threshold-Prof.OPHT
G152A VisualEvokedResponse-Threshold-Tech.OPHT
G202A Hyposensitisation ALLERGY
G271A AnticoagulantSupervisionSPECIFIC ELEMENT
G307A PacemakerPulseWaveAnalysis+ECG-Prof CARD
G310A Electrocardiography - technical component CARD
G311A InterpretTelephoneTransmittedECG-Tech CARD
G313A Electrocardiography - Professional Comp. CARD
G358A GrouthHormoneExerciseStimulatTestENDOCRI
G365A Periodic Pap Smear
G369A B.C.G.inoculation INJECTONS
G370A I.M. Injections INJECTIONS
G371A 2nd injection joind/bursa INJECTIONS
G372A Intramuscular-with visit-each injection
G373A Intramuscular-sole reason-1st injection
G378A InsertIntrauterineContraceptiveDeviceGYN
G385A TriggerPoint-EachAdditionalSiteINJECTION
G394A Additional Papanicolaou Smear GYNECOLOGY
G396A Injection of extensive keloidsINJECTIONS
G420A Ear Syringe OTOLARYNGOLOGY
G480A Vascular: Venipuncture-infantCARDIOVASCUL
G481A Hemoglobin LAB MEDICIANE
G482A Venipuncture - Child
G489A Vascular: Venipuncture - adolescent/adult
G517A BloodFlowStudy:AnklePressureDeterminCARD
G525A Diagnostic Hearing Test
G538A Immunization Injection (TB/MMR/Td/etc.)
G539A Immunization Injection - Sole Reason
G540A Prolonged EEG Monitoring-1/4hour-technic
G590A Immunization - Influenza Agent - with visit
G591A Immunization - Influenza Agent - Sole Reason
G660A ElectrocardiographyEventRecorder-professionalCARD
G857A Visual Fields-kinetic-Tech.OPHTHALMOLOGY
J159A Pregnanc: CompleteOnAfter16WkGestatiULTRA
J320A A-a OxygeGradientRequiringMeasurePULMONA
J323A O2 Saturation By Oximetry At Rest, PULMONARY
J330A AssessmentOfExerciseInducedAsthmaPULMONA
J332A OxygenSaturatByOximetryAtRest&ExercisePU
K001A Detention (First 1/4 hour)
K002A Interview:WithRelatives(1/2hr or Majo)FP
K003A Interview: C.A.S./Guardian(1/2hrOrMajo)FP
K004A Family Psychotherapy
K005A Primary Mental Health – Individual Care (per unit)
K007A Individual Psychotherapy
K008A Interview:DiagnoConselPsychoLearnDisabFP
K010A Psychotherapy: Group - per member FP
K011A Hypnotherapy: Group - per member FP
K012A Psychotherapy: Group - four people FP
K013A Counseling per ½ hour
K015A Counseling Relatives FP
K016A Genetic: Assessment FP/GENET
K017A Annual Health Exam (2-17 yrs)
K021A Sexual Assault Exam (M) FP
K022A HIV: Individual Care - per unit FP
K025A Psychotherapy: Group - 6 to 12 people FP
K028A STD Managemant
K030A Diabetic Management Assessment
K036A Northern Travel Grant Application
K039A Smoking cessation follow-up visit
K040A Hypnotherapy:Group Counseli-2 or more FP
K050A MCFSC HSR and ADL amalgamated form
K053A Social Services Report
K054A MCFSC Mandatory Spec. necessities ban.
K055A MCFSC Special Diet Application Form
K070A Home Care Application
K071A Acute Home Care Supervision
K101A Detention in amb. per 1/4hr
K203A GroupPsychotherapy-4out-patients1/2hrPSY
K205A Group Psychotherapy:6-12outPatient1/2h PSY
M010A RhinotomyApproach-ExciseInterNasalLesion
N188A Minor nerve-including digital & cutaneou
O100A Ordering Diagnositic Procedures
P003A New O.B.S.
P004A Minor Prenatal Assessment
P005A Antenatal preventative assess
P008A Post Partum Visit
PC001A Counsult services-clients wellness team
Q001A Pap Smear Preventive Care Service Enhancement
Q002A Mammography Preventive Care Service Enhancement
Q003A Influenza Preventive Care Service Enhancement
Q005A PREVENTATIVE CARE - COLORECTAL SCREENING
Q011A TRACKING CODE FOR PAP SMEAR
Q013A NEW PATIENT FEE
Q107A PAP SMEAR PREVENTIVE CARE BONUS (70% OF TARGET)
Q114A MAMMOGRAPHY PREVENTIVE CARE BONUS (75% OF TARGET)
Q116A CHILD IMMUNIZATION PREVENTIVE CARE BONUS (90% OF TARGET)
Q123A PREVENTIVE CARE BONUS - COLORECTAL SCREENING 70%
Q131A MAMMOGRAM TRACKING CODE
Q133A COLORECTAL SCREENING TRACKING CODE
Q140A PAP SMEAR EXCLUSION
Q141A MAMMOGRAM EXCLUSION
Q142A COLORECTAL EXCLUSION
Q150A FOBT DISTRIBUTION AND COUNSELLING FEE
Q152A FOBT COMPLETION FEE
Q180A RN-WELL BABY CARE
Q181A RN-MEDICATION REVIEW AND BLOOD PRESSURE CHECK
Q182A RN-DIABETIC CHECK
Q183A RN-CHOLESTEROL CHECK
Q184A RN-COUNSELING
Q400A TELEPHONE ADVICE TO HOME CARE PROVIDERS
Q500A ATTEND CONSULT WITH NURSE - PER UNIT
Q509A ATTEND CONSULT WITH OPTOMETRIST- PER UNIT
Q514A ATTEND CONSULT WITH ABORIGINAL HEALER- PER UNIT
Q515A ATTEND CONSULT WITH NURSE PRACTITIONER- PER UNIT
Q516A ATTEND CONSULT WITH DIETICIAN- PER UNIT
Q526A SPECIALIST CONSULT WITH MENTAL HEALTH/SOCIAL WORKER
Q527A SPECIALIST CONSULT WITH DIETICIAN
Q528A SPECIALIST CONSULT WITH NURSE PRACTITIONER
Q531A SPECIALIST CONSULT WITH OPTOMETRIST
Q532A SPECIALIST CONSULT WITH OTHER HEALTH CARE PROFESSIONAL
Q533A SPECIALIST PROGRAM SUPPORT AND DEVELOPMENT
Q534A MEDICAL STUDENT SUPERVISION BY SPECIALIST
Q535A RESIDENT SUPERVISION BY SPECIALIST
Q541A SPECIALIST PARTICIPATION IN RESEARCH/CLINICAL TRIALS
Q555A CONTINUING MEDICAL EDUCATION MAINPRO-C
Q556A CONTINUING MEDICAL EDUCATION MAINPRO-M1
Q557A CONTINUING MEDICAL EDUCATION OTHER
Q601A Minor Assess - N.P.
Q602A Gen. Asses - N.P.
Q603A Intermed Assess- N.P.
Q604A Chronic Disease Management - per unit - N.P.
Q605A Antenatal Preventive Health Assessment - N.P.
Q606A Prenatal Care - Gen. Assess - Major Prenatal Visit - N.P.
Q607A Prenatal Care - Min. Assess - Subseq. Prenatal Visit- N.P.
Q611A Low Birth Weight Baby Care Initial Visit - N.P.
Q612A Low Birth Weight Baby Care Subseq. Visits - N.P.
Q613A Well Baby Care - N.P.
Q614A Annual Health Exam - Well Child (2-15 years) - N.P.
Q615A Annual Health Exam - Well Adolescent (16-17 years) - N.P.
Q616A Annual Health Exam - Well Adult (18+ years)- N.P.
Q618A Telephone Advice/Counselling
Q619A Screening for risk
Q622A Smoking Cessation counselling - N.P
Q625A Referral to provider
Q626A Delegated activity
Q628A Consultation - N.P.
Q629A Limited Consultation - N.P.
Q630A Referral to specialist - N.P.
Q631A Pre-dental/Oper Assess - N.P.
Q637A Interview Per. Author. to Make Treat. Decis- per unit - N.P.
Q638A Interview on Behalf of Patient per unit - N.P.
Q639A Diag. Interview with Child &/or Parent - per unit - N.P.
Q642A Sexually Transmitted Disease Management - per unit - N.P.
Q652A Allergy Hypo sensitization- N.P.
Q653A Allergy Hypo sensitization - Sole reason for visit - N.P.
Q654A Allergy-Insect Venom Desensitization - N.P.
Q662A Injections - Intradermal/Musc. Etc. Ea Add. - N.P.
Q663A Inj. Intradermal/Musc. Basic Fee (Shick test)- N.P.
Q667A Glucose, quantative or semi quantative Etc - N.P.
Q669A Pregnancy urine test - N.P.
Q670A Urinalysis without Microscopy- N.P.
Q671A Fungus Culture Incl. Koh & Smear- N.P.
Q672A Wet Preparation (For Fungus, Trich.Para)- N.P.
Q673A Streptococcus In Office- N.P.
Q674A Hemoglobin Screen and/or HCT - In Office - N.P.
Q679A Removal of Intrauterine contraceptive device - N.P.
Q680A Insertion of Intrauterine contraceptive device - N.P.
Q681A AddÆl Pap Smear - Followup of Abnorm or Inadeq Smears - N.P.
Q683A Chem/Cryosurg.-genital Condylomata - single/multiple - N.P.
Q684A Vulva-Inc.-Abscesses-Bartholin,SkeneÆs Gland - N.P.
Q688A Immunization - With Visit, Each Inject - N.P.
Q689A Immunization - Sole Reason, First Injection - N.P.
Q690A Influenza Agent - With Visit, Each Injection - N.P.
Q691A Influenza Agent Sole Reason - N.P.
Q700A Occult Blood- N.P.
Q701A Chem and/or cryotherapy treat. of min. skin lesions,- N.P.
Q702A Wound Closure with adhesive - N.P.
Q706A Suture removal- N.P.
Q710A Removal of Foreign Body in External Ear - Simple - N.P.
Q711A Removal of Foreign Body in Nose - Simple - N.P.
Q713A Nose - Epistaxis - Anterior Packing - N.P.
Q714A Otolar. - Syringing & Exten. CurettÆg/Debridement - N.P.
Q718A Certificate of Med Elig. OHCAP- Without Assoc. Visit - N.P.
Q719A Mandatory Reporting of Medical Condition to MTO - N.P.
Q720A Northern Health Travel Grant Application - N.P.
Q721A ODSP Health Status Report and Act. of Daily Living - N.P.
Q723A Completion of forms - school/sports activities
Q724A Ontario Works Program Limitations to Participate Form - N.P.
Q725A Mandatory Special Necessities Benefit Request Form - N.P.
Q726A Special Diet Application Form - N.P.
Q727A Home Care Application - N.P
Q728A Detention in ambulance - Ground trans with pt.per unit -N.P.
Q729A Detention in ambulance - Air transfer with pt per unit -N.P.
Q730A Detention in ambulance - Return trip no pt. to origin -N.P.
R043A XanthelasCongenit derm cyst-Infant/Child
R239A FIB/TIB Sequestrectomy
R249A Inc. Sequestrectomy Pelvis
R637A RescMajBurnDebrid/Exci(noHandHeadNeck)
R679A HypertelorisCorrecMedial/LateraOrbiWallO
S002A Excise Parapharyngeal Space Lesion
TM100A Traditional Medicine Individual Counsel
TM110A Traditional Medicine Family Counsel
TM120A Traditional Medicine Teachings
TM170A Prenatal Assessment
TM180A Traditional Birthing
TM190A Prenatal Teachings
TM200A Medicine Harvesting
TM210A Cultural Competency
TM220A Cultural Safety
TM230A Feast
TM240A Indian Residential School Support
TM250A Traditional Health Assessment
TM260A Traditional Support
TM270A Client Intake/Interview
TM280A Traditional Medicine Referral
TM290A Aromatherapy
TM300A Reflexology
TM310A Massage Therapy
V101A Recurrent Chiropractor Visit
V103A Initial Chiropractor Visit
V303A Chiropodist-Subsequent Office Visit
V305A Chiropodist-Initial Visit
W001A Chronic/Convales:AdditionSubseqVisits FP
W872A Paliative care FP
W903A Pre-dental/pre-operative gen Assessment FP
Z094A Plast.Surg. GA-RemoveTissExpan.Inje.Port
Z101A Inc. Loc.Anes. Subcu.Abscess/Hematoma x1
Z104A Inc.LocAnes. Abscess/Hematoma Perianal
Z113A Inc. Biopsy(s), any method, NO sutures
Z114A Inc.Foreign Body Removal - Local Anes.
Z116A Inc.- Biopsy(s) any method, sutures used
Z117A Chemical Treatment of Lesion 1+
Z125A Excision Local Anes. Other Cyst x 1
Z128A Nail excision (with anesthesia) x 1
Z153A Major Debridement Wound
Z154A SutureLacerations Close in Layers <5cm
Z157A Mole Removal by excision and suture x 2
Z163A Nevus Removal by Excision & Suture x 2
Z166A Excision & Suture - Plantar Wart x 1
Z169A Wart Removal by Electrocoag/Curette x 1
Z174A Inc.LocalAnes.Subcut.Abscess/Hematomax3+
Z201A Finger Splint/Cast
Z202A Hand splint/cast
Z203A Arm, Forearm, Wrist Splint/Cast
Z230A Biopsy Bone- punch, x-ray control
Z605A Aspiration
Z730A Follow Up Colposcopy
Z731A CervixUteriEndoscop(AbnormalCytology)
Z732A Cryotherapy
Z756A Fecal disimpaction - no anesthetic
Z770A Endometrial Sampling
Z847A Removal Foreign Body-Local Anaesethetic
Z852A General Anaesthetic
Z864A General AnestheticUnilateral Or Bilateral
Z869A Biopsy Bone - punch, simple, core
Z874A Chalazion-Single or Multiple-Local Anaes
FSC-MOH Description F08-09 Numbers Note
MINOR ASSESS.-F.P./G.P. 3689 freq. used
18 MONTH WELL BABY CHECK -GP/FP #N/A include
GEN. ASSESS. -F.P./G.P. 1039 freq. used
GEN.RE-ASSESS-F.P./G.P. 55 freq. used
CONSULTATION -F.P./G.P. 1 include
RE-CONSULTATION-F.P./G.P. 40 include
INTERMED.ASSESS/WELL BABY CARE-F.P./G.P./PAED. 3981 freq. used
MINI ASSESSMENT-F.P./G.P. 80 include
OCULO-VISUAL ASSESS.-F.P./G.P. 2 include
SPECIFIC ASSESS.-ANAES. 3 include
PARTIAL-ASSESS. -ANAES. 1 include
RE-CONSULT.-DERM. 1 include
CONSULT.-NEURO-SURG. 4 freq. used
COMMUNITY MEDICINE CONSULTATION - OFFICE 1 include
MEDICAL SPECIFIC ASSESSMENT 7 include
PERIODIC OCULO-VISUAL ASSESS 19 & UNDER 3 include
#N/A 18 custom
SPECIFIC ASSESS.-PSYCHIATRY 1 include
CONSULT.-PSYCHIATRY 1 include
#N/A 1 custom
GENETIC MINOR ASSESSMENT 1 include
MEDICAL SPECIFIC ASSESSMENT-PAED 95 include
MEDICAL SPECIFIC RE-ASSESSMENT-PAED 13 include
CONSULT.-PAED. 2 include
LABORATORY MEDICINE MEDICAL SPECIFIC ASSESSMENT 2 include
LABORATORY MEDICINE PARTIAL ASSESSMENT 7 include
GENERAL/FAMILY PRACTICE-HOUSECALL ASSESSMENT 3 include
GEN/FAM PRACT-PRE-DENTAL/OPER.ASSESS LIMIT 2 PER YEAR/PT 51 freq. used
SPEC.VISIT,7.00AM-12.00M.NMON-FRI.1ST PT SEEN OFF/HOSP/EMERG 2 include
SUBSEQ.VISITS-TO 5WKS-F.P./G.P.-HOSP. 2 include
#N/A #N/A custom
#N/A 7 custom
#N/A 14 custom
#N/A 38 custom
#N/A 4 custom
MIDWIFE - REQUESTED EMERGENCY ASSESSMENT 4 include
MIDWIFE - REQUESTED SPECIAL EMERGENCY ASSESSMENT 18 include
#N/A 93 custom
#N/A #N/A custom
IDENTIFICATION OF PATIENT FOR MAJOR EYE EXAM AGE 20 TO 64 2 include
#N/A 9 custom
#N/A 1 custom
#N/A 10 custom
OPER.MUSCULOSKEL.SYST-DECOMPRESSION POSTER.W MULT.LEVELS 2 include
#N/A 1 custom
#N/A 237 custom
#N/A #N/A custom
D./T. PROC.-LAB.MED.-CHOLESTEROL TOTAL. 94 include
D./T. PROC-LAB.MED.-GLUCOSE QUANTITATIVE OR SEMI QUANTITATIV 150 freq. used
D./T. PROC-LAB.MED.-OCCULT.BLOOD. 18 include
D./T. PROC-LAB.MED.-PREGNANCY TEST. 79 freq. used
D./T. PROC-LAB.MED.-SGOT. 5 include
D./T. PROC-LAB.MED.-UREA NITROGEN (B.U.N.). 3 include
D./T. PROC-LAB.MED.-URINALYSIS ROUTINE ETC. 74 include
D./T. PROC-LAB.MED.-URINALYSIS- ONE OR MORE PARTS.W/0.MICRO. 382 freq. used
D./T. PROC-LAB.MED.-FUNGUS CULTURE INCL. KOH & SMEAR. 1 include
D./T. PROC-LAB.MED.-WET PREPARATION (FOR FUNGUS, TRICH,PARA) 1 include
LAB.MED.STREPTOCOCCUS IN OFFICE 8 include
D/T.PROC.OPHTHALM.EVOKED POTENT'L-VISUAL THRESHOLD PROF (P1) 1 include
D/T.PROC.OPHTHALM.EVOKED POTENT'L-VISUAL THRESHOLD TECH 1 include
D./T. PROC.-ALLERGY-HYPOSENSITIZATION 1 include
D./T. PROC.-CARDIOV.-ANTICOAGULANT SUPERVISION 9 include
D./T. PROC.-CARDIOV-PACEMAKER WAVE ANALYSIS/ECG-PROF COMP 3 include
D./.T.PROC.CARDIOV.ECG TECHNICAL COMP. 74 freq. used
D./T. PROC.-CARDIOV.-CARDIOGRAPHY-TELEPHONE TRANSMIS. TECH. 1 include
D./.T.PROC CARDIOV ECG PROF.COMP-G.P. 2 include
D./T. PROC.-GASTROENT.-GROWTH HORMONE TEST-PHYS. PRESENT 1 include
D./T. PROC.-GYNAECOLOGY-PAPANICOLAOU SMEAR 534 freq. used
D./T. PROC.-INJECTION/INFUSION-B.C.G. INOCULATION 2 include
D/T PROC.INJ/INF.BURSA JOINT GANGLION TENDON SH.ASPIR'N 13 include
D./T. PROC.-INJECTION/INFUSION-BURSA,ETC. EA. ADD. SITE 1 include
D./T. PROC.-INJECTIONS-INTRADERMAL/MUSCULAR ETC. EA. ADD. 115 include
D./T. PROC.-INJ. INTRADERMAL/MUSC. BASIC FEE (SHICK TEST) 45 freq. used
D./T. PROC. GYNAECOLOGY-INSERTION OF IUD 11 include
D./T. PROC.-AS G384-MORE THAN ONE SITE (ADD) 1 include
ADD'L PAP SMEAR FOR FOLLOWUP OF ABNORM OR INADEQ SMEARS 10 include
D./T. PROC.-INJ./INFUSION-INJ. OF EXTENSIVE POST BURN KELOID 3 include
D&T,OTOLAR.-SYRINGING&/EXTEN.CURETT'G/DEBRIBEM'T N/A W Z907 16 freq. used
D./T. PROC.-VENIPUNCTURE-INFANT 4 include
D./T. PROC-CARDIO-HGB SCREEN/HCT.-PHYS.OFFICE-WITH VISIT 74 include
D./T. PROC.-VENIPUNCTURE-CHILD 8 freq. used
D./T. PROC.-VENIPUNCTURE- ADOL./ADULT. 980 freq. used
D&T CARDIO BLOOD FLOW STUDY-ANKLE PRESSURE DETERMINATION 1 include
OTOLARYNG.DIAG.HEARING TEST PROF.COMP.TO G440 74 freq. used
D&T IMMUNIZATION-WITH VISIT, EACH INJECT. 342 freq. used
D&T IMMUNIZATION-SOLE REASON,FIRST INJECTION 52 freq. used
NEUROL-VIDEOTAPE RECORD CLIN SIGNS WITH EEG ETC.TECH TO G545 2 include
INFLUENZA AGENT +VISIT 221 include
INFLUENZA AGENT SOLE REASON 126 include
D&T-CARDIOVAS.CONTINU.ECG.MONITOR'G EVENT RECORD'R-PROF.COMP 3 include
D&T,OPHTHALMOLOGY-VISUALFIELDS,KINETIC(W REC.) TECH.COMP. #N/A freq. used
DIAG ULTRASOUND COMPLETE ON/AFTER 16 WEEKS GESTATION 1 include
PULM/FUNC-GAS ANALYSIS-A-A OXYGEN GRADIENT. 4 include
PUL.FUNCT.O2 SATURATION BY OXIMETRY 1 freq. used
PULM.FUNC.-EXERCISED INDUCED ASTHMA ASSESS. BEFORE/AFTER 1 include
PUL.FUNCT.OXYGEN SATURATION BY OXIMETRY NOT BILLED WITH J323 8 include
DETENTION FEE PER FULL 1/4 HR 11 include
INTERVIEWS-RELATIVES ON BEHALF OF PATIENT PER 1/2 HOUR 32 include
INTERVIEW ON BEHALF OF PATIENT (CAS,LEG.GUARD) PER 1/2HR. 3 include
FAMILY PSYCHOTHERAPY-2/MORE MEMBERS-PER 1/2HR. 5 freq. used
INDIVIDUAL CARE PER 1/2 HR #N/A freq. used
IND. PSYCHOTHERAPY PER HALF HOUR - GP 137 freq. used
DIAG.INTERVIEW W/CHILD &/OR PARENT-PER 1/2HR. 8 include
PSYCHOTHERAPY-GROUP-PER MEMBER PER1/2HR 7TH TO 9TH HR 1 include
HYPNOTHERAPY-GROUP-MAX.8- PER 1/2HR.-PER MEMBER. 1 include
GROUP PSYCHOTHERAPY-FOUR PEOPLE PER 1/2 HR PER MEMBER 2 include
COUNSELLING-ONE OR MORE PEOPLE-PER 1/2HR. 548 freq. used
COUNSELLING-RELATIVE ON BEHALF OF PT.SEE PARA.B20 (C) #N/A freq. used
GENETIC ASSESSMENT PATIENT OR FAMILY, DIRECT CONTACT, PER 1 include
ANNUAL HEALTH EXAM-CHILD AFT. 2ND BIRTHDAY. 23 freq. used
SEXUAL ASSAULT INVESTIGATION-MALE 1 include
HIV PRIM CARE INDIVID CARE 1/2 HR OR MAJOR PART 1 include
GENERAL/FAMILY PRACT.-GR.PSYCHOTHERAPY-6 TO 12 PEOPLE 3 include
SEXUALLY TRANSMITTED DISEASE (STD) COUNSELING 6 include
DIABETIC MANAGEMENT FEE 40 include
NORTHERN HEALTH TRAVEL GRANT FORM 1 include
SMOKING CESSATION FOLLOW-UP VISIT 12 include
GROUP COUNSEL - 2 +PTS WITH NO K013/K040X3 1 include
MCFCS-FORMS HEALTH STATUS REPORT AND DAILY LIVING INDEX 9 include
MCSS ONT WORK PROG MEDICAL REPORT FORM 3 include
MCFCS-FORM-MANDATORY SPECIAL NECESSITIES BENEFIT 9 include
MCFCS-FORM-SPECIAL DIET APPLICATION 30 include
HOME CARE APPLICATION 10 include
ACUTE HOME CARE SUPERVISION 3 include
DETENTION FEE WITH PATIENT IN AMBULANCE-PER 1/4 HOUR 4 include
GROUP PSYCHOTH-OUT-PATIENT-4 MEMBERS TO 6 HRS. 1 include
GROUP PSYCHOTH-OUT-PATIENT-6-12 MEMBERS TO 6 HRS. 2 include
NOSE-EXC.-INTRANASAL LESIONS-LAT. RHINOTOMY APPROACH. 3 include
NERV.SYST.EXPL./DECOMPR.MINOR NERVE E.G. DIGITAL OR CUTANEOU 2 include
#N/A 6 custom
OBS.-PRENATAL CARE-GEN.ASSESS-MAJOR PRENATAL VISIT 36 include
OBS.-PRENATAL CARE-MINOR PRENATAL ASSESS.-SUBSEQ.PRENAT.VIS. 58 freq. used
ANTENATAL HEALTH SCREEN 5 include
OBS.-POST-NATAL CARE IN OFFICE 10 include
#N/A #N/A custom
PAP SMEAR PREVENTIVE CARE SERVICE ENHANCEMENT 87 include
MAMMOGRAPHY PREVENTIVE CARE SERVICE ENHANCEMENT Yes
INFLUENZA PREVENTIVE CARE SERVICE ENHANCEMENT Yes
PREVENTATIVE CARE - COLORECTAL SCREENING Yes
TRACKING CODE FOR PAP SMEAR Yes
NEW PATIENT FEE Yes
PAP SMEAR PREVENTIVE CARE BONUS (70% OF TARGET) Yes
MAMMOGRAPHY PREVENTIVE CARE BONUS (75% OF TARGET) Yes - one of these
CHILD IMMUNIZATION PREVENTIVE CARE BONUS (90% OF TARGET) Yes
PREVENTIVE CARE BONUS - COLORECTAL SCREENING 70% Yes - one of these
MAMMOGRAM TRACKING CODE Yes
COLORECTAL SCREENING TRACKING CODE Yes
PAP SMEAR EXCLUSION Yes
MAMMOGRAM EXCLUSION Yes
COLORECTAL EXCLUSION Yes
FOBT DISTRIBUTION AND COUNSELLING FEE Yes
FOBT COMPLETION FEE Yes
RN-WELL BABY CARE Yes
RN-MEDICATION REVIEW AND BLOOD PRESSURE CHECK Yes
RN-DIABETIC CHECK Yes
RN-CHOLESTEROL CHECK Yes
RN-COUNSELING Yes
TELEPHONE ADVICE TO HOME CARE PROVIDERS Yes
ATTEND CONSULT WITH NURSE - PER UNIT Yes
ATTEND CONSULT WITH OPTOMETRIST- PER UNIT Maybe
ATTEND CONSULT WITH ABORIGINAL HEALER- PER UNIT Yes
ATTEND CONSULT WITH NURSE PRACTITIONER- PER UNIT Yes
ATTEND CONSULT WITH DIETICIAN- PER UNIT Yes
SPECIALIST CONSULT WITH MENTAL HEALTH/SOCIAL WORKER Yes
SPECIALIST CONSULT WITH DIETICIAN Yes
SPECIALIST CONSULT WITH NURSE PRACTITIONER Yes - need more info
SPECIALIST CONSULT WITH OPTOMETRIST Maybe
SPECIALIST CONSULT WITH OTHER HEALTH CARE PROFESSIONAL Maybe
SPECIALIST PROGRAM SUPPORT AND DEVELOPMENT Yes - need more info
MEDICAL STUDENT SUPERVISION BY SPECIALIST No - need for MD
RESIDENT SUPERVISION BY SPECIALIST No - need for MD
SPECIALIST PARTICIPATION IN RESEARCH/CLINICAL TRIALS Yes
CONTINUING MEDICAL EDUCATION MAINPRO-C Yes - need more info
CONTINUING MEDICAL EDUCATION MAINPRO-M1 Yes - need more info
CONTINUING MEDICAL EDUCATION OTHER Yes - need more info
Minor Assess - N.P. Yes
Gen. Asses - N.P. Yes
Intermed Assess- N.P. Yes
Chronic Disease Management - per unit - N.P. Yes
Antenatal Preventive Health Assessment - N.P. Yes
Prenatal Care - Gen. Assess - Major Prenatal Visit - N.P. Yes
Prenatal Care - Min. Assess - Subseq. Prenatal Visit- N.P. Yes
Low Birth Weight Baby Care Initial Visit - N.P. Yes
Low Birth Weight Baby Care Subseq. Visits - N.P. Yes
Well Baby Care - N.P. Yes
Annual Health Exam - Well Child (2-15 years) - N.P. Yes
Annual Health Exam - Well Adolescent (16-17 years) - N.P. Yes
Annual Health Exam - Well Adult (18+ years)- N.P. Yes
Telephone Advice/Counselling Yes
Screening for risk Yes - need more info
Smoking Cessation counselling - N.P Yes
Referral to provider Yes - need more info
Delegated activity Yes - need more info
Consultation - N.P. Yes - need more info
Limited Consultation - N.P. Yes - need more info
Referral to specialist - N.P. Yes
Pre-dental/Oper Assess - N.P. Yes
Interview Per. Author. to Make Treat. Decis- per unit - N.P. Yes - need more info
Interview on Behalf of Patient per unit - N.P. Yes - need more info
Diag. Interview with Child &/or Parent - per unit - N.P. Yes - need more info
Sexually Transmitted Disease Management - per unit - N.P. Yes
Allergy Hypo sensitization- N.P. Yes - need more info
Allergy Hypo sensitization - Sole reason for visit - N.P. Yes - need more info
Allergy-Insect Venom Desensitization - N.P. Yes - need more info
Injections - Intradermal/Musc. Etc. Ea Add. - N.P. Yes - need more info
Inj. Intradermal/Musc. Basic Fee (Shick test)- N.P. Yes - need more info
Glucose, quantative or semi quantative Etc - N.P. Yes - need more info
Pregnancy urine test - N.P. Yes
Urinalysis without Microscopy- N.P. Yes
Fungus Culture Incl. Koh & Smear- N.P. Yes - need more info
Wet Preparation (For Fungus, Trich.Para)- N.P. Yes
Streptococcus In Office- N.P. Yes - need more info
Hemoglobin Screen and/or HCT - In Office - N.P. Yes - need more info
Removal of Intrauterine contraceptive device - N.P. Yes
Insertion of Intrauterine contraceptive device - N.P. Yes
AddÆl Pap Smear - Followup of Abnorm or Inadeq Smears - N.P. Yes
Chem/Cryosurg.-genital Condylomata - single/multiple - N.P. Yes
Vulva-Inc.-Abscesses-Bartholin,SkeneÆs Gland - N.P. Yes - need more info
Immunization - With Visit, Each Inject - N.P. Yes but usually RN
Immunization - Sole Reason, First Injection - N.P. Yes but usually RN
Influenza Agent - With Visit, Each Injection - N.P. Yes but usually RN
Influenza Agent Sole Reason - N.P. Yes but usually RN
Occult Blood- N.P. Yes - need more info
Chem and/or cryotherapy treat. of min. skin lesions,- N.P. Yes but usually Z117
Wound Closure with adhesive - N.P. Yes
Suture removal- N.P. Yes but usually RN
Removal of Foreign Body in External Ear - Simple - N.P. Yes
Removal of Foreign Body in Nose - Simple - N.P. Yes
Nose - Epistaxis - Anterior Packing - N.P. Yes
Otolar. - Syringing & Exten. CurettÆg/Debridement - N.P. Yes
Certificate of Med Elig. OHCAP- Without Assoc. Visit - N.P. Yes - need more info
Mandatory Reporting of Medical Condition to MTO - N.P. Yes
Northern Health Travel Grant Application - N.P. Yes
ODSP Health Status Report and Act. of Daily Living - N.P. Yes
Completion of forms - school/sports activities Yes
Ontario Works Program Limitations to Participate Form - N.P. Yes
Mandatory Special Necessities Benefit Request Form - N.P. Yes
Special Diet Application Form - N.P. Yes
Home Care Application - N.P Yes
Detention in ambulance - Ground trans with pt.per unit -N.P. Yes - need more info
Detention in ambulance - Air transfer with pt per unit -N.P. Yes - need more info
Detention in ambulance - Return trip no pt. to origin -N.P. Yes - need more info
SKIN&SUBCUT.REMOV.CONGEN.DERMOID CYST-INFANT OR CHILD 1 include
BONES-FIB/TIB SEQUESTRECTOMY 2 include
BONES-INC.-SEQUESTRECTOMY-PELVIS. 4 include
SKIN-BURNS-DEBRIDEMENT AND EXCISION. 1 include
BONES-RECONSTR-HYPERTEL.CORREC.MED.& LAT.ORBIT WALL OSTEOT. 1 include
PHARYNX-EXC.-PARAPHARYNGEAL SPACE LESIONS 7 include
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
#N/A #N/A custom
CHIROPRACTOR-SUBSEQUENT VISIT (OFFICE/INST.) 166 include
CHIROPRACTOR-INITIAL SERVICE (OFFICE/INST.) 73 include
CHIROPODIST-SUBSEQUENT OFFICE VISIT #N/A include
CHIROPODIST-INITIAL OFFICE VISIT #N/A include
SUBSEQ.VISITS GP.CHR/CONVAL HOSP/LTIC MAX 6PER PAT.PER MONT 2 include
TERMINAL CARE N.H G.P/FAMILY PRACTICE 1 include
GEN/FAM PRACT-PREDENTAL/OPER.GEN ASSESS LIMIT 2 PER YEAR/PT. 2 include
SKIN&SUBCUTAN.TISSUE-REMOVAL TISSUE EXPAN.INJ.PORT SOLE,GA. 6 include
SKIN-INC.-ABSCESS-SUBCUT.-ONE -LOC.ANAES. 10 include
SKIN-INC.-ABSCESS-PERIANAL-LOCAL ANAES 1 include
INTEGUMENTARY SYST.BIOPSY(S)-ANY METHOD,SUTURES NOT USED 1 include
SKIN-INC.-FOREIGN BODY-LOC. ANAES. #N/A freq. used
SURG.PROC SKIN-BIOPSY(S)ANY METHOD WHEN SUTURES USED 8 include
SKIN.CHEM/CRYOTHERAPY MINOR SKIN LESIONS 1/MORE 48 freq. used
SKIN-EXC.-GROUP 4-OTHER AREAS-ONE LESION-LOC. ANAES. 2 include
SKIN-DESTRUCTION FINGER/TOENAIL PART/COMP./NAIL PLATE EXC.1 2 include
SKIN.DEBRIDE&DRESS'G MAJOR(NOT WITH Z176) 4 include
SKIN-SUTURE LACER.-UPTO 5CM.-FACE-TIE BLEEDERS/LAYERS. 1 include
SKIN-EXC-SUT.-BENIGN LESIONS-TWO LESIONS. 1 include
SKIN-EXC-SUT.-NAEVUS-TWO. 17 include
SKIN-EXC-SUT.-PLANTAR-ONE. #N/A freq. used
SKIN & SUBCUT.-PLANTAR-REMOVAL BY ELECTRO.-SINGLE LESION 1 include
SKIN-INC.-SUBCUT-LOC.ANAES. THREE/MORE ABSCESSES/HAEMATOMAS 1 include
BONES-APPLIC.-PLASTER/CAST/SPLINTS FINGER #N/A freq. used
BONES-APPLIC. PLASTER/CAST/SPLINTS HAND #N/A freq. used
BONES-APPLIC.-PLASTER/CASTS/SPLINTS-ARM/FOREARM/WRIST #N/A freq. used
BONES-BIOPSY-PUNCH,X-RAY CONTR.-HAND/WRIST. 1 include
BLADDER-INCISION-ASPIRATION 1 include
CERVIX UTERI-ENDOSCOPY-COLPOSCOPY-FOLLOW UP. 1 include
UTERUS/CERVIX-INVEST. ABNORMAL CYTOLOGY,COLPOSCOPIC TECHNIQ. 1 include
UTERUS/CERVIX-CAUTERY-CRYOTHERAPY 20 include
RECTUM-FECAL DISIMPACTION-NO ANAES. #N/A freq. used
ENDOMETRIAL SAMPLING 2 include
EYE-CORNEA-INCISION-REM. SINGLE EMBEDDED FOREIGN BODY LOC. 1 freq. used
EYE-CORNEA-REMOVAL EMBEDDED FOREIGN BODY-GEN. ANAES include
LACRIMAL TRACT-PROBE/DILATE DUCT-UNIL/BIL-GEN. ANAES. 2 include
BONES-EXC-BIOPSY-NEEDLE/PUNCH-OTHER-SIMPLE. 1 include
EYELID-EXC.-CHALAZION-SINGLE/MULTIPLE-LOC. ANAES. 1 include
Yes - one of these
Yes - one of these
Yes - need more info
Yes - need more info
No - need for MD
No - need for MD
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Yes but usually RN
Yes but usually RN
Yes but usually RN
Yes but usually RN
Yes - need more info
Yes but usually Z117
Yes but usually RN
Yes - need more info
Yes - need more info
Yes - need more info
Yes - need more info
Service Code Service Description
A123A Additional Diagnosis
A200A Arranging for Services
C100A Case Conference
C500A Consultation - other internal
C510A Consultation MD - verbal
C520A Consultation MD - written
C600A Consultation - other external
D200A Discussion re: treat/serv for diagn/test
D230A Dressing/Packing
E120A Smoking Cessation Counselling
E130A Sexual Health Counselling
E200A Contraception and Counselling
E700A Healthy Lifestyle
E999A Form Completion
F001A Fitness Evaluation
O100A Ordering Diagnositic Procedures
PC001A Counsult services-clients wellness team
TM100A Traditional Medicine Individual Counsel
TM110A Traditional Medicine Family Counsel
TM120A Traditional Medicine Teachings
TM170A Prenatal Assessment
TM180A Traditional Birthing
TM190A Prenatal Teachings
TM200A Medicine Harvesting
TM210A Cultural Competency
TM220A Cultural Safety
TM230A Feast
TM240A Indian Residential School Support
TM250A Traditional Health Assessment
TM260A Traditional Support
TM270A Client Intake/Interview
TM280A Traditional Medicine Referral
TM290A Aromatherapy
TM300A Reflexology
TM310A Massage Therapy
Service Code Service Description
Q001A Pap Smear Preventive Care Service Enhancement
Q002A Mammography Preventive Care Service Enhancement
Q003A Influenza Preventive Care Service Enhancement
Q005A PREVENTATIVE CARE - COLORECTAL SCREENING
Q011A TRACKING CODE FOR PAP SMEAR
Q013A NEW PATIENT FEE
Q107A PAP SMEAR PREVENTIVE CARE BONUS (70% OF TARGET)
Q114A MAMMOGRAPHY PREVENTIVE CARE BONUS (75% OF TARGET)
Q116A CHILD IMMUNIZATION PREVENTIVE CARE BONUS (90% OF TARGET)
Q123A PREVENTIVE CARE BONUS - COLORECTAL SCREENING 70%
Q131A MAMMOGRAM TRACKING CODE
Q133A COLORECTAL SCREENING TRACKING CODE
Q140A PAP SMEAR EXCLUSION
Q141A MAMMOGRAM EXCLUSION
Q142A COLORECTAL EXCLUSION
Q150A FOBT DISTRIBUTION AND COUNSELLING FEE
Q152A FOBT COMPLETION FEE
Q180A RN-WELL BABY CARE
Q181A RN-MEDICATION REVIEW AND BLOOD PRESSURE CHECK
Q182A RN-DIABETIC CHECK
Q183A RN-CHOLESTEROL CHECK
Q184A RN-COUNSELING
Q400A TELEPHONE ADVICE TO HOME CARE PROVIDERS
Q500A ATTEND CONSULT WITH NURSE - PER UNIT
Q509A ATTEND CONSULT WITH OPTOMETRIST- PER UNIT
Q514A ATTEND CONSULT WITH ABORIGINAL HEALER- PER UNIT
Q515A ATTEND CONSULT WITH NURSE PRACTITIONER- PER UNIT
Q516A ATTEND CONSULT WITH DIETICIAN- PER UNIT
Q526A SPECIALIST CONSULT WITH MENTAL HEALTH/SOCIAL WORKER
Q527A SPECIALIST CONSULT WITH DIETICIAN
Q528A SPECIALIST CONSULT WITH NURSE PRACTITIONER
Q531A SPECIALIST CONSULT WITH OPTOMETRIST
Q532A SPECIALIST CONSULT WITH OTHER HEALTH CARE PROFESSIONAL
Q533A SPECIALIST PROGRAM SUPPORT AND DEVELOPMENT
Q534A MEDICAL STUDENT SUPERVISION BY SPECIALIST
Q535A RESIDENT SUPERVISION BY SPECIALIST
Q541A SPECIALIST PARTICIPATION IN RESEARCH/CLINICAL TRIALS
Q555A CONTINUING MEDICAL EDUCATION MAINPRO-C
Q556A CONTINUING MEDICAL EDUCATION MAINPRO-M1
Q557A CONTINUING MEDICAL EDUCATION OTHER
Q601A Minor Assess - N.P.
Q602A Gen. Asses - N.P.
Q603A Intermed Assess- N.P.
Q604A Chronic Disease Management - per unit - N.P.
Q605A Antenatal Preventive Health Assessment - N.P.
Q606A Prenatal Care - Gen. Assess - Major Prenatal Visit - N.P.
Q607A Prenatal Care - Min. Assess - Subseq. Prenatal Visit- N.P.
Q611A Low Birth Weight Baby Care Initial Visit - N.P.
Q612A Low Birth Weight Baby Care Subseq. Visits - N.P.
Q613A Well Baby Care - N.P.
Q614A Annual Health Exam - Well Child (2-15 years) - N.P.
Q615A Annual Health Exam - Well Adolescent (16-17 years) - N.P.
Q616A Annual Health Exam - Well Adult (18+ years)- N.P.
Q618A Telephone Advice/Counselling
Q619A Screening for risk
Q622A Smoking Cessation counselling - N.P
Q625A Referral to provider
Q626A Delegated activity
Q628A Consultation - N.P.
Q629A Limited Consultation - N.P.
Q630A Referral to specialist - N.P.
Q631A Pre-dental/Oper Assess - N.P.
Q637A Interview Per. Author. to Make Treat. Decis- per unit - N.P.
Q638A Interview on Behalf of Patient per unit - N.P.
Q639A Diag. Interview with Child &/or Parent - per unit - N.P.
Q642A Sexually Transmitted Disease Management - per unit - N.P.
Q652A Allergy Hypo sensitization- N.P.
Q653A Allergy Hypo sensitization - Sole reason for visit - N.P.
Q654A Allergy-Insect Venom Desensitization - N.P.
Q662A Injections - Intradermal/Musc. Etc. Ea Add. - N.P.
Q663A Inj. Intradermal/Musc. Basic Fee (Shick test)- N.P.
Q667A Glucose, quantative or semi quantative Etc - N.P.
Q669A Pregnancy urine test - N.P.
Q670A Urinalysis without Microscopy- N.P.
Q671A Fungus Culture Incl. Koh & Smear- N.P.
Q672A Wet Preparation (For Fungus, Trich.Para)- N.P.
Q673A Streptococcus In Office- N.P.
Q674A Hemoglobin Screen and/or HCT - In Office - N.P.
Q679A Removal of Intrauterine contraceptive device - N.P.
Q680A Insertion of Intrauterine contraceptive device - N.P.
Q681A AddÆl Pap Smear - Followup of Abnorm or Inadeq Smears - N.P.
Q683A Chem/Cryosurg.-genital Condylomata - single/multiple - N.P.
Q684A Vulva-Inc.-Abscesses-Bartholin,SkeneÆs Gland - N.P.
Q688A Immunization - With Visit, Each Inject - N.P.
Q689A Immunization - Sole Reason, First Injection - N.P.
Q690A Influenza Agent - With Visit, Each Injection - N.P.
Q691A Influenza Agent Sole Reason - N.P.
Q700A Occult Blood- N.P.
Q701A Chem and/or cryotherapy treat. of min. skin lesions,- N.P.
Q702A Wound Closure with adhesive - N.P.
Q706A Suture removal- N.P.
Q710A Removal of Foreign Body in External Ear - Simple - N.P.
Q711A Removal of Foreign Body in Nose - Simple - N.P.
Q713A Nose - Epistaxis - Anterior Packing - N.P.
Q714A Otolar. - Syringing & Exten. CurettÆg/Debridement - N.P.
Q718A Certificate of Med Elig. OHCAP- Without Assoc. Visit - N.P.
Q719A Mandatory Reporting of Medical Condition to MTO - N.P.
Q720A Northern Health Travel Grant Application - N.P.
Q721A ODSP Health Status Report and Act. of Daily Living - N.P.
Q723A Completion of forms - school/sports activities
Q724A Ontario Works Program Limitations to Participate Form - N.P.
Q725A Mandatory Special Necessities Benefit Request Form - N.P.
Q726A Special Diet Application Form - N.P.
Q727A Home Care Application - N.P
Q728A Detention in ambulance - Ground trans with pt.per unit -N.P.
Q729A Detention in ambulance - Air transfer with pt per unit -N.P.
Q730A Detention in ambulance - Return trip no pt. to origin -N.P.
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