Fee Navigator®

    Health Service Code 03.01MT

    Completion of a Physician Report form under the Mandatory Testing and Disclosure Act


    May only be claimed for preparing Physician's report as outlined in the Mandatory Testing and Disclosure Act when requested by a patient for purposes of seeking a court order to require a source individual to submit to testing for blood-borne infections.

    Category:V Visit
    Base rate:$74.18

    Fee modifiers:

    No modifiers.

    Governing Rules:

    • 3.1

      The following includes examples of, but is not limited to, services which are not a benefit under the Schedule and may not be claimed:

      1. Advice by telephone or other telecommunication methods except as specified under specific HSCs or for telehealth services;
      2. Ambulance services, except ambulance detention time HSCs 13.99K, 13.99KA, 13.99KB;
      3. Anesthetic materials;
      4. Any service a physician provides to his/her children, grandchildren, siblings, parents, grandparents, spouse or adult interdependent partner or any person who is dependent on the practitioner for support in accordance with the Alberta Health Care Insurance Regulation;
      5. Drugs/agents;
      6. Intravenous sedation for dental procedures administered to a patient who is not an inpatient or registered outpatient of a hospital;
      7. Medical appliances;
      8. Medical testimony in court, except psychiatric opinion at psychiatric review panel under the Mental Health Act;
      9. Secretarial or reporting fees;
      10. Stand-by time;
      11. Travel time of a practitioner to see a patient;
      12. Services requested or required by a third party. Examples include but are not limited to:
        • Examinations or certification related to adoption;
        • Medical examinations to indicate fitness to attend camp;
        • Autopsies;
        • Employment examinations and reports;
        • Examinations and reports requested under the auspices of the Child Welfare Act;
        • Immigration requirements;
        • Insurance/disability reports and forms;
        • Examinations and reports for judicial purposes (e.g., requested by police);
        • Medical-legal reports requested by patients or by lawyers on behalf of patients with the exception of HSC 03.01MT;
        • Motor vehicle license;
        • Examinations and forms relating to participation in sports;
        • Examinations and forms relating to university or other school requirements;
        • Passport and visa applications;
      13. Pre-travel assessments, counseling or administration of vaccines or drugs for travel purposes to reduce the patient's risk of acquiring an illness, or for prevention of communicable diseases not endemic to Canada;
      14. Administration of vaccines such as Hepatitis A and B is not covered unless specifically otherwise communicated by Alberta Health.