TOSC OR Billing Request

Section 01

Surgeon & Billing Party

Surgeon name*

Surgeon name is required.

Anesthesiologist name

Billing entity / company

Billing address

Your email address*

A valid email address is required.

CC email

Please enter a valid email or leave blank.

Section 02

Surgery Details

Date of surgery*

Date of surgery is required.

OR / room number*

Room number is required.

Total OR time (hours)*

Auto-calculated as the sum of each case's surgical time below, unless the surgical day override beneath is used. Drives the facility fee calculation for hourly rates.

Enter start and end times on each case to calculate the total OR time.

Surgical day start and/or end time is different from the case times

Cases & anesthesia*

List each case for the day with its start and end times, the anesthesia arrangement, and the consumables report for that case. Surgical time is calculated per case and summed into the Total OR time above. TOSC uses this to invoice you for facility use and to arrange payment to the anesthesiologist where applicable. The supplement applies to pure OHIP cases only. For any case where the anesthesiologist bills OHIP directly for anesthesia time (pure OHIP or the OHIP portion of a combo case), enter those minutes so we can auto-deduct that time from the facility fee at $400/hr, since we are not paying our anesthesiologist for that time.

This surgery day was MPR cases only. Check this to remove the OR case boxes. Only the Minor Procedure Cases box will be captured, with no surgical times or consumables reports. This is for OVERNIGHT STAY ONLY. Check this to remove the OR case boxes. Only the Overnight Stay box will be captured, with no surgical times or consumables reports.

At least one case entry is required.

Section 03

Facility Fee

Select the single facility fee that applies to the day. For a booked MPR day or half day using a TOSC nurse, choose the MPR half-day or full-day rate. For a one-off MPR case where FORM is bringing its own nurse and no TOSC nurse is used, choose MPR one-off (no facility charge) and add the appropriate tray fee in Additions. If the day is a combination, for example first half Standard OR and second half Emergency Takeback, submit a separate form for each fee type. If the surgeon has a negotiated hourly rate that differs from the standard rates, choose Custom and enter the agreed rate.

Facility fee notes

Please select a facility fee option.

Section 04

Additions

Select any add-on charges. Quantities default to 1.

Section 05

Deductions

Select any credits back to the surgeon or clinic.

Section 06

Attachments & Authorization

Billing Total

Facility Fee$0.00

Additions$0.00

Deductions-$0.00

Grand Total$0.00

Grand Total is what the surgeon owes TOSC, and includes the Supplemental Anesthesia Fee (on pure OHIP cases). Private anesthesia time on combo cases is captured for the record but not billed separately (already inside the facility fee). OHIP anesthesia time is auto-deducted at $400/hr since our anesthesiologist bills OHIP directly for that portion. If the surgeon brings their own anesthesia (checked in Deductions), the OHIP auto-deduction is skipped since their external arrangement is independent.

Rate Calculator

$ per Operating Hour (w/o deductions)

Optional convenience. Divides billed revenue (Facility + Additions + Supplement, before any deductions) plus any post-case consumables by operating hours.

Operating hours

Facility Fee (from the form)$0.00

Additions (from the form)$0.00

Supplemental Anesthesia Fee$0.00

Estimated Consumables ($)