Templates & Handouts

  • Template Client Consent Form. In order for physicians/laboratories to get paid, they need to submit an invoice to the TPA that contains the midwifery client’s name. Since TPAs may need to confirm that an invoice is for a client who is a midwifery care, it is good practice to get your clients to sign a consent form that gives permission for their personal health information to be shared with the TPA. This template consent form has been reviewed by HIROC for this purpose.
  • Handout for Uninsured Clients Regarding Costs of Care. This handout describes the types of services a client might need during pregnancy and any associated costs. It is ideally given to an uninsured client upon intake into midwifery care.
  • Template Letter for Physicians/Diagnostic Invoicing. This letter must be attached by midwives to any requisition/referrals for uninsured clients to enable the physician/diagnostician to invoice the TPA.
  • Template Letter to Hospital for Uninsured Midwifery Patients. This letter informs the hospital that there is an uninsured midwifery client who will need to set up a payment plan at the hospital.
  • Memo from OMP to Labs. The OMP sent this memo describing the uninsured funding to all operators of community licensed laboratories in Ontario and the Ontario Association of Medical Laboratories in July, 2015. If a lab is hesitant to accept the uninsured billing letter, this memo can be used as an education and advocacy tool.