How to report new active leprosy — and autofill form 14-5054-64 with my-id.ca
Notify public health of new active leprosy without retyping patient identifiers
Physicians and laboratories reporting suspected or confirmed new active leprosy cases to the medical officer of health repeat patient name, contact details, and clinical identifiers on Form 3. This guide is an example of storing them once in my-id.ca.
Official form and source
Start from the official source and always use the current version — form numbers and links can change:
- Service page: Reports regulation (Reg. 569) — ontario.ca
- Form (Central Forms Repository): Form 3 — Notification of New Active Leprosy (Hansen's Disease) — 14-5054-64
What this form is about
Form 14-5054-64 is Form 3 — Notification of New Active – Leprosy (Hansen's Disease), the prescribed report under Ontario Regulation 569 for leprosy cases of public health significance.
Before you start: what to gather
- Patient full legal name and date of birth.
- Patient address and contact phone.
- Reporting physician or laboratory name and contact.
- Clinical and laboratory findings — confirm reporting timelines with your local public health unit.
Confirm the current process on ontario.ca.
How my-id.ca makes it faster
- Save it once. Store your patient name, address, and reporter contact details in your my-id.ca profile.
- Keep documents ready. Upload supporting documents to my-id.ca Files so you are not searching at form time.
- Autofill the form. Use the my-id.ca Chrome extension on a web form, or fill a PDF from your saved profile inside my-id.ca.
- Review and submit yourself through the official channel.
Why do it in my-id.ca
Related Ontario forms repeat the same personal details. Captured once in my-id.ca — stored in Canada, with AI on its own servers — every form starts mostly complete.
Frequently asked questions
- Who must report leprosy?
- Persons required to report diseases of public health significance under the Health Protection and Promotion Act — confirm obligations on ontario.ca.
- How does my-id.ca help?
- It autofills patient names and addresses; reporters can reuse clinic contact profiles.
- Where do I send the form?
- Submit to your local medical officer of health — contact details vary by public health unit.
Fill it once. Reuse it everywhere.
Save your information in my-id.ca once, then autofill this form and the next one — web forms with the Chrome extension, PDFs right in the app. Your data is stored in Canada and AI runs on my-id.ca's own servers, never sent to third-party AI providers.