How to complete a new patient enrolment declaration — and autofill 014-4367-84 with my-id.ca

Enrol new primary care patients without retyping physician and patient identifiers

Physicians enrolling new patients in primary care models repeat physician billing numbers, practice addresses, and each patient's name and health number on every new patient declaration. 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: Resources for physicians — ontario.ca
• Form (Central Forms Repository): Primary Health Care New Patient Declaration — 014-4367-84

What this form is about

Form 014-4367-84 is the Primary Health Care New Patient Declaration used when a physician or group enrols a new patient in an Ontario patient enrolment model — confirm model rules on ontario.ca.

Before you start: what to gather

• Physician legal name and OHIP billing number.
• Group billing number if enrolling under a group practice.
• Patient full legal name, date of birth, and Ontario health number.
• Enrolment effective date and patient signature requirements.

Confirm the current process on ontario.ca.

How my-id.ca makes it faster

1. Save it once. Store your physician billing number, practice address, and patient health number in your my-id.ca profile.
2. Keep documents ready. Upload supporting documents to my-id.ca Files so you are not searching at form time.
3. 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.
4. 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.