Nunavut residents use this one-page claim to recover costs such as accommodation, meals, taxis, prescriptions and medical supplies under the Department of Health's Extended Health Benefits. The clinician's part is the Record of Appointment(s), where the attending physician or community health nurse signs to confirm each medical appointment. The claimant attaches original receipts and certifies that any insurance was claimed first.
The attending physician or designate, or the community health nurse, prints their name, dates and signs one line per appointment in the Record of Appointment(s). The claimant completes the patient and claimant details, claim description and declaration, and can sign for a patient under 18 or unable to sign.
Download the current version from the source each time; forms change without notice.
Extended Health Benefits Claim Form
If your copy of the form is a fillable PDF, upload it 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.
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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The attending physician or their designate, or a community health nurse. Each appointment gets its own line with the clinician's printed name, the date and a signature, confirming the patient attended the medical appointment linked to the expenses claimed. The form has room for several appointments on one claim.
The claim description lists accommodation, meals, taxi, prescriptions and medical supplies, with a total, and original receipts must be attached. For residents eligible for EHB Medical Travel Support, coverage can also include flight co-payments under the Medical Travel Policy and ground transportation between accommodation, health facilities and the airport.
Yes. The Government of Nunavut's form page offers an online version that steps through the Record of Appointment(s), patient and claimant information, and the declaration before a preview, alongside the downloadable PDF. Either way, the claim goes to the Extended Health Benefits section of the Department of Health.