Referral of a patient to Ontario Health atHome for home and community care services.
- Completed by
- Referring physician, NP or other provider
- Issued by
- Ontario Health atHome
- Format
- Language
- English
OHIP Form 2743-84: Approval for Dental Procedures
Dentists and oral surgeons use this bilingual request to ask the Ministry of Health to approve payment, before surgery, for dental procedures to be performed in hospital. The dentist describes the diagnosis, proposed procedure and medical reasons for hospitalization, and names the attending physician. A ministry medical consultant approves, amends or declines the request, and an approved copy is returned with the claim.
Who completes it
The dentist completes Part 1: patient details, attending physician, hospital and admission date, diagnosis and proposed procedure, medical indication for hospitalization, and their dentist identification number and signature. The ministry completes the assessment section.
Submitting and payment
- How to submit it
- Forward all copies to the Medical Consultant at the dentist's Ministry of Health office; if the request is approved, return the dentist's copy with the claim.
- Who pays
- Approved benefits are limited to dental services listed in the Dental Schedule of Benefits under the Health Insurance Act, and the form lists no fee for completing the request.
Good to know
- Surgery must take place in a public hospital graded Group A, B, C or D under the Public Hospitals Act, and Ontario health coverage must be in effect on the date of service.
- Hospitalization and the related general anaesthesia are insured even when the dental procedure is not, except anaesthesia for impacted teeth whose extraction the ministry has not approved.
- Provide a medical report supporting hospitalization when one is available; the medical indication section asks for the specific reasons the patient needs a hospital setting.
- The 2743-84 (2022/12) edition prints English and French on the same page and is completed in two copies, one for the dentist and one for the ministry.
Get the official form
Download the current version from the source each time; forms change without notice.
Request for Approval of Payment for Proposed Dental Procedures
Demande d'approbation du règlement d'honoraires pour actes bucco-dentaires proposés
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Frequently asked questions
Who completes OHIP form 2743-84?
The dentist or oral surgeon planning the procedure completes Part 1, including the attending physician's name and address, the hospital, the diagnosis and proposed procedure, and the medical indication for hospitalization. The dentist signs with their dentist identification number, and the ministry records its decision in the assessment section.
Is general anaesthesia for in-hospital dental work insured?
According to the form, hospitalization and the associated general anaesthesia for dental procedures done in hospital are insured whether or not the dental procedure itself is insured. The exception is general anaesthesia for removing impacted teeth when the ministry has not approved the extraction as a benefit.