Forms Repository

Form 7000-1 - Request for Medical/Dental Advance

• When to Use: For medical expenses >$400 that require upfront payment
• Requirements:
  • Minimum $400 advance
  • Cost estimate required for amounts over $500
  • Repayment within 6 months (9 months for pregnancy)
  • Provider cost estimate or invoice required
• Submit to: CDLSW-MedicalAdmin-ELFCW-AdminMedical@forces.gc.ca
• Additional Required: Completed DND 432 form

DND 432 - Request for Accountable Advance of Public Funds

• Must be submitted with 7000-1 form to arrange advancec with FIN Section.
• Creates the accountable advance that member must pay back once healthcare claims have been rectified. 
• As this is an accountable advance, member may need to provide updates in regards to the claim process for costs paid by the advance. 

Annual Personnel Medical Readiness Attestation Form

• Form provided by the medical records clerk
• Must be signed and submitted during the birth month to complete the medical portion of your Annual Personal Readiness Verification
• Covers the entire review period
• Attestation Form - EN | Attestation Form - FR

DND 4943 - Periodic Health Assessment Questionaire

• This is a fillable PDF that is replacing the DND 2552. 
• Provides information to help identify preventative health screening.
• Can request follow-up with CFMLO directly through the form.
• Should be submitted with the Annual Medical Attestation for all non-aircrew and aircrew not in an active flying position yearly.
• The form takes between 5-10 minutes to complete to the best of your ability.
• DND 4943 PHA Questionnaire - EN | DND 4943 PHA Questionnaire - FR

DND 2552 - Patient Questionnaire

• Required for medical category updates
• Submit with clinical notes to CAFMLO
• Available on Defence Forms Catalogue

DND 2452 - Aircrew and Driver Health Examination

• Required annually for aircrew/drivers in active flying positions to retain air factor
• Submit with aircrew medical, audiogram, and visual exam completed by Flight Surgeon
• Available on Defence Forms Catalogue

CF 52 - General Allowance Claim

• Used for various expense reimbursements
• Medical administration will complete on your behalf
• Include proof of payment and authorization

MSH International Claims

• Online Portal: pshcp-msh.ca/a/register
• Form: "MSH Comprehensive Claims Incurred Outside Canada"
• Timeline: ~30 day reimbursement

DoD 2870 - Authorization for Disclosure of Medical Information

• Required to obtain medical records from MTFs
• Submit to clinic reception or medical records
• Allows release of your medical information
• Can send DoD SAFE link directly to Medical Records Clerk at Natalia.Pela@forces.gc.ca

DND 4342 - Statement of Dependant Health

• Complete sections 1 and 2 for extensions
• Section 3 required for cross-postings outside U.S.
• One form required for each dependant

Annex B of 5020-66

• Parts 1 and 2 completed and signed by member
• Spouse signature required if applicable
• Required for all screening requests

Medical Administration

Email: CDLSW-MedicalAdmin-ELFCW-AdminMedical@forces.gc.ca
For Form 7000-1 and medical advances

Medical Records Clerk

Email: Natalia.Pela@forces.gc.ca
For annual declaration and DND 2552

CAFMLO

Email: gerren.martin@forces.gc.ca
Phone: 202-448-6210
For screening forms and medical guidance