Akumin (AKUMQ) 40-F/A 29 Apr 21 2020 FY Annual report (Canada) (amended) Financial data

Cover Page

Cover Page	12 Months Ended
	Dec. 31, 2020shares
Cover [Abstract]
Document Type	40-F/A
Amendment Flag	true
Document Period End Date	Dec. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	FY
Trading Symbol	AKU
Entity Registrant Name	AKUMIN INC.
Entity Central Index Key	0001776197
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Title of 12(b) Security	Common Shares
Security Exchange Name	NASDAQ
Document Annual Report	true
Document Registration Statement	false
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding	70,178,428
Amendment Description	Akumin Inc. (the “Company” or the “Registrant”) is a “foreign private issuer” as defined in Rule 3b-4 under Securities Exchange Act of 1934, as amended (the “Exchange Act”), and is a Canadian issuer eligible to file its annual report (“Annual Report”) pursuant to Section 13 of the Exchange Act on Form 40-F pursuant to the multi-jurisdictional disclosure system (the “MJDS”) adopted by the United States Securities and Exchange Commission (the “SEC”). The Company’s common shares are listed on the Toronto Stock Exchange and the Nasdaq Global Select Market (“Nasdaq”) under the trading symbol “AKU”. The Registrant is permitted under MJDS to file with this Annual Report certain reports and other information prepared in accordance with Canadian disclosure requirements, which are different from those of the United States. On October 1, 2020, the Registrant adopted United States generally accepted accounting principles (“U.S. GAAP”). The Registrant’s Audited Consolidated Financial Statements for the year ended December 31, 2020, filed as Exhibit 99.6 to this Annual Report, including required comparative information for 2019, have been prepared in accordance with U.S. GAAP. The financial information for the year ended December 31, 2020 included in the Annual Information Form of the Company for the year ended December 31, 2020 (the “AIF”), filed as Exhibit 99.4 to this Annual Report, is prepared in accordance with U.S. GAAP.
Entity Address, State or Province	FL
ICFR Auditor Attestation Flag	false

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Current assets
Cash	$ 44,395,988	$ 23,388,916
Accounts receivable	91,126,923	82,867,225
Prepaid expenses and other current assets	3,942,268	3,927,949
Assets, Current	139,465,179	110,184,090
Security deposits and other assets	4,876,208	1,967,053
Property and equipment (note 4)	79,929,574	75,938,590
Operating lease right-of-use assets (note 3)	127,061,894	126,675,770
Goodwill (notes 3 and 6)	360,603,613	358,802,534
Intangible assets (note 5)	6,748,073	9,432,480
Total assets	718,684,541	683,000,517
Current liabilities
Accounts payable and accrued liabilities (note 7)	34,233,142	26,262,225
Finance lease liabilities (note 9)	3,264,806	1,789,995
Operating lease liabilities (right-of-use) (notes 3 and 9)	9,345,656	9,276,298
Senior loans payable (note 10)	405,698	3,705,952
Earn-out liability (note 8)	4,688,553	7,529,962
Liabilities, Current	51,937,855	48,564,432
Finance lease liabilities (note 9)	12,308,780	6,625,409
Operating lease liabilities (right-of-use) (notes 3 and 9)	122,953,656	119,773,692
Senior loans payable (note 10)	389,580,046	336,276,370
Derivative financial instruments (note 10)		951,702
Subordinated notes payable – earn-out (note 11)		184,485
Earn-out liability (note 8)		7,304,105
Accrued payroll taxes (note 25)	1,346,088
Deferred tax liability	826,566	6,256,820
Total liabilities	578,952,991	525,937,015
Shareholders' equity
Additional paid-in capital (common shares: no par value, unlimited authorized number of shares, 70,178,428 and 69,840,928 shares issued and outstanding as of December 31, 2020 and December 31, 2019, respectively) (notes 12 and 15)	160,965,034	158,881,120
Deficit	(26,759,151)	(6,361,767)
Equity attributable to shareholders of Akumin Inc.	134,205,883	152,519,353
Non-controlling interests (note 24)	5,525,667	4,544,149
Total shareholders' equity	139,731,550	157,063,502
Total liabilities and shareholders' equity	$ 718,684,541	$ 683,000,517

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Common Stock, No Par Value	$ 0	$ 0
Common Stock, Shares Authorized, Unlimited	Unlimited	Unlimited
Common Stock, Shares, Issued	70,178,428	69,840,928
Common Stock, Shares, Outstanding	70,178,428	69,840,928

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Service fees - net of allowances and discounts	$ 243,981,183	$ 244,841,400
Other revenue	7,301,666	2,594,903
Revenues	251,282,849	247,436,303
Operating expenses
Cost of operations, excluding depreciation and amortization (note 22)	197,803,388	187,802,601
Depreciation and amortization (notes 4 and 5)	20,459,767	15,587,200
Stock-based compensation (notes 12 and 15)	2,083,914	3,554,765
Operational financial instruments revaluation and other (gains) losses (note 20)	(3,907,666)	1,017,401
Total operating expenses	216,439,403	207,961,967
Income from operations	34,843,446	39,474,336
Other income and expenses
Interest expense (notes 9 and 10)	32,781,210	20,783,438
Other financial instruments revaluation and other (gains) losses (note 20)	22,078,745	1,805,816
Settlement costs and other (recoveries) (note 23)	2,324,151	(1,881,233)
Acquisition-related costs	1,079,255	3,403,160
Total other expenses (income)	58,263,361	24,111,181
Income (loss) before income taxes	(23,419,915)	15,363,155
Income tax provision (benefit) (note 13)	(5,751,070)	3,735,548
Net income (loss) and comprehensive income (loss) for the period	(17,668,845)	11,627,607
Non-controlling interests (note 24)	2,728,539	2,199,629
Net income (loss) attributable to common shareholders	$ (20,397,384)	$ 9,427,978
Basic and diluted	$ (0.29)	$ 0.14

Consolidated Statements of Chan

Consolidated Statements of Changes in Equity - USD ($)	Total	Additional paid-in capital [Member]	Accumulated Deficit [Member]	Non-controlling interest [Member]
Beginning Balance at Dec. 31, 2018	$ 118,895,463	$ 130,577,709	$ (15,789,745)	$ 4,107,499
Net income and comprehensive income	11,627,607		9,427,978	2,199,629
Acquisition consideration (note 12)	23,437,500	23,437,500
RSUs and Warrants exercised (note 12)	1,311,146	1,311,146
Stock-based compensation expense (notes 12 and 15)	3,554,765	3,554,765
Payment to non-controlling interests (note 24)	(1,762,979)			(1,762,979)
Ending Balance at Dec. 31, 2019	157,063,502	158,881,120	(6,361,767)	4,544,149
Net income and comprehensive income	(17,668,845)		(20,397,384)	2,728,539
Stock-based compensation expense (notes 12 and 15)	2,083,914	2,083,914
Payment to non-controlling interests (note 24)	(1,747,021)			(1,747,021)
Ending Balance at Dec. 31, 2020	$ 139,731,550	$ 160,965,034	$ (26,759,151)	$ 5,525,667

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Operating activities
Net income (loss) for the period	$ (17,668,845)	$ 11,627,607
Adjustments for:
Depreciation and amortization	20,459,767	15,587,200
Stock-based compensation (notes 12 and 15)	2,083,914	3,554,765
Interest expense-accretion of debt and paid-in-kind interest	5,482,307	2,047,214
Deferred income tax expense (benefit)	(5,430,254)	2,092,504
Financial instruments revaluation and other (gains) losses	18,171,079	2,823,217
Changes in operating assets and liabilities
Accounts receivable	(8,259,697)	(25,243,156)
Prepaid expenses, security deposits and other assets	(138,395)	(3,657,429)
Accounts payable and accrued liabilities	9,038,102	1,369,580
Operating lease liabilities and right-of-use assets	2,952,575	2,379,575
Net Cash Provided by (Used in) Operating Activities	26,690,553	12,581,077
Investing activities
Purchase of property and equipment and intangible assets	(13,420,375)	(12,447,634)
Business acquisitions – net of cash acquired (note 3)	(3,198,634)	(218,659,981)
Other investments	(463,789)	0
Net Cash Provided by (Used in) Investing Activities	(17,082,798)	(231,107,615)
Financing activities
Loan proceeds (note 10)	406,300,000	354,114,000
Loan repayments (note 10)	(371,524,423)	(113,887,167)
Issuance costs – loans	(15,216,138)	(14,781,765)
Finance leases – principal payments	(1,524,548)	(904,193)
Subordinated notes or earn-out (note 11)	(200,000)	(1,500,000)
Earn-out liability (note 8)	(4,688,553)	0
Common shares (note 12)	0	1,311,146
Payment to non-controlling interests	(1,747,021)	(1,762,979)
Net Cash Provided by (Used in) Financing Activities	11,399,317	222,589,042
Increase in cash during the period	21,007,072	4,062,504
Cash – Beginning of period	23,388,916	19,326,412
Cash – End of period	44,395,988	23,388,916
Supplementary information
Interest expense paid	22,844,479	18,882,263
Income taxes paid	$ 1,172,464	$ 487,598

Presentation of Consolidated Fi

Presentation of Consolidated Financial Statements and Nature of Operations	12 Months Ended
	Dec. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Presentation of Consolidated Financial Statements and Nature of Operations	1 Presentation of consolidated financial statements and nature of operations The operations of Akumin Inc. (Akumin or the Company) and its Subsidiaries (defined below) primarily consist of operating outpatient diagnostic imaging centres located in Delaware, Florida, Georgia, Illinois, Kansas, Pennsylvania and Texas. Substantially all of the centres operated by Akumin were obtained through acquisition. Related to its imaging centre operations, Akumin also operates a medical equipment business, SyncMed, LLC (SyncMed), which provides maintenance services to Akumin’s imaging centres in Illinois, Kansas and Texas and a billing and revenue cycle management business, as a division of Akumin’s wholly owned indirect subsidiary, Akumin Corp., which was previously operated by a subsidiary, Rev Flo Inc., which was merged into Akumin Corp. on December 31, 2018. The services offered by the Company (through the Subsidiaries) include magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), nuclear medicine, mammography, ultrasound, digital radiography (X-ray), The Company has a diverse mix of payers, including private, managed care, capitated and government payers. The registered and Canadian head office of Akumin is located at 151 Bloor Street West, Suite 603, Toronto, Ontario, M5S 1S4. The United States head office is located at 8300 W. Sunrise Boulevard, Plantation, Florida, 33322. All operating activities are conducted through its wholly owned US subsidiary, Akumin Holdings Corp. and its wholly owned subsidiary, Akumin Corp. Akumin Corp. operates its business directly and through its key wholly owned direct and indirect subsidiaries, which include Akumin Florida Holdings, LLC, formerly known as Tri-State

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2020
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2 Summary of significant accounting policies The Company adopted the accounting principles generally accepted in the United States of America (GAAP) as the basis of preparation for the comparative 2020 and 2019 annual financial statements effective for the fiscal year-ended December 31, 2020. Previously, the Company’s financial statements were prepared in accordance with International Financial Reporting Standards (IFRS) as issued by the International Accounting Standards Board (IASB), for the period up to and including the 9-months 40-F 51-102 The preparation of consolidated financial statements in accordance with GAAP requires the use of estimates and assumptions that affect the reported amounts of revenue, expenses, assets, liabilities and contingencies. Although actual results in subsequent periods may differ from these estimates, such estimates are developed based on the best information available to management and based on management’s best judgments at the time. The Company bases its estimates on historical experience, observable trends and various other assumptions that we believe are reasonable under the circumstances. All significant assumptions and estimates underlying the amounts reported in the consolidated financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected prospectively in the consolidated financial statements based upon on-going The most significant assumptions and estimates underlying these consolidated financial statements involve accounts receivable, impairments of long-lived assets including goodwill, operating lease right-of-use-assets, The significant accounting policies described below have been applied consistently to all periods presented. Principles of consolidation The consolidated financial statements include all of the accounts of the Company, the Subsidiaries and the Revenue Practices. All intercompany transactions and balances have been eliminated on consolidation. Variable interest entities In accordance with the FASB’s ASC Topic 810, Consolidation As a result of the financial relationship established between the Company and the Revenue Practices through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, The Company has a variable interest in a single purpose entity in Texas which operates an imaging center. The Company also has a variable interest in certain operations of an imaging center of another Texas entity. In both cases, the Company is not a primary beneficiary of the variable interest since it does not have any equity ownership in these entities nor does it have the power to direct the activities of either of these entities that most significantly impact the entities’ economic performance. Rather, in both cases, the Company is entitled to a management fee based upon written agreements in exchange for certain agreed upon management services. The assets and liabilities and revenue and expenses of these entities are not included in the consolidated financial statements of the Company. Functional and reporting currency and foreign currency translation The functional and reporting currency of the Company, the Subsidiaries and the Revenue Practices is US dollars. Monetary assets and liabilities denominated in foreign currencies are translated into US dollars at the rates of exchange prevailing at the consolidated balance sheet dates. Non-monetary Cash Cash includes cash on hand and cash held with banks. Property and equipment Property and equipment are recorded at cost and are depreciated over their estimated useful lives using the straight line method, as follows: Medical equipment and equipment under finance leases six years Computer and office equipment four to five years Furniture and fittings nine years Leasehold improvements over term of lease Expenditures for maintenance and repairs are charged to operations as incurred. Operating lease right-of-use Intangible assets The Company classifies intangible assets, obtained through acquisitions or developed internally, as definite lived. Intangible assets consist of software costs, trade name, license arrangements and covenants not to compete; these intangible assets are recorded at cost and are amortized over their estimated useful lives, using the straight line method, as follows: Software costs, trade name and license arrangements five to six years Covenant not to compete over term of contract The Company reviews the appropriateness of the amortization period related to the definite lived intangible assets annually. Goodwill In January 2017, FASB issued Accounting Standards Update (ASU) 2017-04, Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment (ASU 2017-04) 2017-04 2017-04 2017-04 2017-04. Goodwill is recognized as the fair value of the consideration transferred, less the fair value of the net identifiable assets acquired and liabilities assumed, as at the acquisition date. Subsequent to initial recognition, goodwill is measured at cost less accumulated impairment losses. Goodwill acquired in business combinations is allocated to reporting units that are expected to benefit from the synergies of the combination. The determination of reporting units and the level at which goodwill is monitored requires judgment by management. The Company’s reporting units generally represent individual business units below the level of the Company’s operating segment. Goodwill is tested annually for impairment as at October 1 or whenever indicators of impairment are present by comparing the carrying amount of the reporting units against its fair value. Impairment of long-lived assets The Company reviews long-lived assets for impairment when events or changes in circumstances indicate the carrying amount of an asset may not be recoverable. If any indication exists, the Company estimates the recoverable amount. The Company assesses the recoverability of the assets based on the undiscounted future cash flows expected from the use and eventual disposition of the asset. If the carrying amount of the asset is determined not to be recoverable, a write-down to fair value is recorded. Fair values are determined based on quoted market values, discounted cash flows, or external appraisals, as applicable. Long-lived assets to be disposed of are reported at the lower of carrying amount or fair value less costs to sell. The amount of the impairment charge is calculated as the excess of the asset’s carrying value over its fair value, which generally represents the discounted future cash flows from that asset or in the case of assets we expect to sell, at fair value less costs to sell. Segment reporting Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. The Company has one reportable segment, which is outpatient diagnostic imaging services. Revenue recognition On January 1, 2019, the Company adopted ASU 2014-09, Revenue from Contracts with Customers (Topic 606) The Company adopted ASC 606 with a full retrospective application. As a result, at the adoption of ASC 606, the majority of what was previously classified as the provision for bad debts in the consolidated statement of operations is now reflected as implicit price concessions (as defined in ASC 606) and therefore included as a reduction to revenue. Net service fee revenue consists of net patient fees received from various payers and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. It primarily comprises fees for the use of the Company’s diagnostic imaging equipment and provision of medical supplies. Service fee revenue is recorded during the period in which the Company’s performance obligations are satisfied, based on the estimated collectible amounts from the patients and third party payers. The Company’s performance obligations are satisfied when services are rendered to the patient. Since the gap between payment and delivery of services to patients is generally expected to be less than one year, the Company does not adjust the service fee revenue for a significant financing component, as a practical expedient. Third party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, attorneys, and employers. Estimates of contractual allowances and the transaction price are based on the terms specified in the related contractual agreements, negotiated rates and historical and expected payment patterns. The Company estimates its expected reimbursement for patients based on the applicable contract terms and negotiated rates. The Company believes its review process enables it to identify instances on a timely basis where such estimates need to be revised. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third party payers, management fees, government grants and fees for other services provided to third parties. Revenue is recorded during the period in which the Company’s performance obligations under the contract are satisfied by the Company. For 2020, the Company received grants from the U.S. Health and Human Services (HHS). Such grants are outside the scope of ASC 606 and are further discussed in note 25. ASC 606 applies a single model for recognizing revenue from contracts with customers. It requires revenue to be recognized in a manner that depicts the transfer of promised goods or services to a customer and at an amount that reflects the consideration expected to be received in exchange for transferring those goods or services. This is achieved by applying the following five steps: i) identify the contract with a customer; ii) identify the performance obligation in the contract; iii) determine the transaction price; iv) allocate the transaction price to the performance obligations in the contract; and v) recognize revenue when (or as) the entity satisfies a performance obligation. Earnings per share Basic earnings per common share (EPS) is calculated by dividing the net earnings available to common shareholders by the weighted average number of common shares outstanding during the year. Diluted EPS is calculated by adjusting the net earnings available to common shareholders and the weighted average number of common shares outstanding for the effects of all dilutive instruments. Income taxes Income tax expense comprises current and deferred tax. Income tax is recognized in the consolidated statements of operations and comprehensive income (loss). Current income tax expense represents the amount of income taxes payable based on tax law that is enacted at the reporting date and is adjusted for changes in estimates of tax expense recognized in prior periods. A current tax liability or asset is recognized for income taxes payable, or paid but recoverable, in respect of all periods to date. The Company uses the asset and liability method of accounting for income taxes. Under this method, deferred tax assets and liabilities are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. A deferred tax asset is recognized for unused tax losses, tax credits and deductible temporary differences, to the extent that it is more likely than not that future taxable income will be available to utilize such amounts. Deferred tax assets are reviewed at each reporting date and are adjusted to the extent that it is no longer probable that the related tax benefits will be realized. When it appears more likely than not that deferred taxes will not be realized, a valuation allowance is recorded to reduce the deferred tax asset to its estimated realizable value. For net deferred tax assets, estimates of future taxable income are considered in determining whether net deferred tax assets are more likely than not to be realized. Deferred tax assets and liabilities are offset when they relate to income taxes levied by the same tax authority and the Company intends to settle its current tax assets and liabilities on a net basis. The Company reports a liability for unrecognized tax benefits resulting from uncertain tax positions taken or expected to be taken in a tax return. The Company recognizes interest and penalties, if any, related to unrecognized tax benefits in income tax expense. Financial instruments Financial assets (such as accounts receivable) and liabilities (such as accounts payable, accrued liabilities, leases and loans) at amortized cost are initially recognized at fair value, and subsequently are carried at amortized cost (using the effective interest rate method) less any impairment. Any premium or discount between amortized cost and fair value is amortized to the consolidated statements of operations and comprehensive income (loss). Derivative financial instruments and earn-outs are initially recognized and subsequently measured at fair value. No derivatives have been designated as a cash flow hedge under ASC 815, Derivatives and Hedging Leases In February 2016, the FASB issued ASU 2016-02. 2016-02’s 2016-02 2016-02 2016-02 On January 1, 2019, the Company recorded right-of-use The Company’s operating lease portfolio primarily consists of real estate leases for its imaging centres and corporate offices. A smaller portion consists of medical and office equipment leases. The Company elected to use the package of practical expedients offered in the transition guidance that allows management not to reassess lease identification, lease classification and initial direct costs. The Company also elected to use the accounting policy practical expedients by class of underlying asset to (i) combine associated lease and non-lease right-of-use Operating lease liabilities were recorded as the present value of remaining lease payments not yet paid for the lease term discounted using the incremental borrowing rate associated with each lease. Operating lease right-of-use right-of-use Variable components of lease payments fluctuating with a future index or rate are estimated at lease commencement based on the index or rate at lease commencement. If the payments change as the result of a change in an index or rate subsequent to lease commencement, the difference is recognized in the income statement in the period in which the change occurs. Variable payments for maintenance such as common area maintenance costs and taxes, are not included in determining lease payments and are expensed as incurred. Most of the Company’s leases do not contain implicit borrowing rates, and therefore to measure lease liabilities, the Company used its incremental borrowing rates at the later of the lease commencement date or January 1, 2019. Lease liabilities will be remeasured when there is a significant change in the lease contracts. Warrants Financial instruments issued by the Company are classified as equity only to the extent they do not meet the definition of a financial liability or financial asset. The Company has issued warrants that are convertible into common stock; these warrants are classified as equity instruments. Restricted share units Restricted share units (RSUs) are issued in accordance with the Company’s RSU Plan, which entitles a holder of one RSU to receive one common share of the Company. RSUs are assigned a value based on the market value of the common shares of the Company on the grant date (or the nearest working day prior to the grant date). Such value is classified as stock-based compensation over the vesting period for all RSUs awarded to employees or the Board (note 12). For RSUs awarded to non-employees Stock-based compensation The Company’s stock-based compensation consists of stock options, which are described in note 15 and RSUs, which are discussed in note 12. Each tranche of a share option award is considered a separate award with its own vesting period and recorded at fair value on the date of grant. The fair value of each tranche is measured at the date of grant using the Black-Scholes option pricing model. Compensation expense is recognized over the tranche’s vesting period based on the number of awards expected to vest by increasing contributed surplus. Any consideration paid upon the exercise of stock options is credited to common stock and the related fair value of those stock options is transferred from the contributed surplus to common stock. Business combinations In January 2019, the Company adopted FASB issued ASU 2017-01, Clarifying the Definition of a Business (2017-01) The Company accounts for business combinations using the acquisition accounting method. The total purchase price is allocated to the assets acquired and liabilities assumed based on fair values as at the date of acquisition. Goodwill as at the acquisition date is measured as the excess of the aggregate of the consideration transferred and the amount of any non-controlling non-controlling Changes in non-controlling The Company treats transactions with non-controlling non-controlling non-controlling Contingencies Loss contingency is an existing condition, situation, or set of circumstances involving uncertainty as to possible loss to an entity that will ultimately be resolved when one or more future events occur or fail to occur. The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. In assessing loss contingencies related to legal proceedings that are pending against the Company or unasserted claims that may result in such proceedings, the Company, with assistance from its legal counsel, evaluates the perceived merits of any legal proceedings or unasserted claims as well as the perceived merits of the amount of relief sought or expected to be sought. Accrued legal costs for legal contingencies are recorded when they are probable and estimable. Accounts receivable Accounts receivable are generally non-interest non-individual COVID-19 COVID-19 Accounts receivable are considered to be in default when customers have failed to make the contractually required payments when due. Implicit price concessions are recorded as a reduction in revenue with an offsetting amount reducing the carrying value of the receivable. When a receivable is considered uncollectible, the receivable is written off against the allowance for bad debts account. In the fourth quarter of 2020, due to slow down in collections of receivables, the Company changed its estimates of the implicit price concessions related to its customers, primarily based on historical experience of collections impacted by the pandemic and the integration of diagnostic imaging centers acquired in 2018 and 2019. The result of this change in estimate resulted in an increase as compared to the year ended December 31, 2019 to the cumulative implicit price concessions for outstanding receivables by approximately $12.3 million ($9.4 million net of tax) in the year ended 2020, or $0.13 per share (basic and diluted) for the three and twelve months ended December 31, 2020.

Business Combinations

Business Combinations	12 Months Ended
	Dec. 31, 2020
Business Combinations [Abstract]
Business Combinations	3 Business combinations i) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Coral Springs, Florida, for cash consideration of approximately $2.1 million (Coral Springs Acquisition). In accordance with the transaction agreement, $100,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Current assets Prepaid expenses 32,961 Non-current Security deposits 368,601 Property and equipment 412,400 Operating lease right-of-use 2,427,618 3,241,580 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 2,427,618 Net assets acquired 813,962 Goodwill 1,274,764 Purchase price 2,088,726 This acquisition was an opportunity for the Company to increase its economies of scale across Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $4.1 million and income before tax of approximately $0.7 million to the Company’s consolidated results for the twelve months ended December 31, 2020. In our estimation, this acquisition would have contributed revenue of approximately $5.4 million and income before tax of approximately $0.9 million to the Company’s consolidated results for the twelve months ended December 31, 2019. ii) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Crystal Lake, Illinois, for cash consideration of approximately $1.2 million (Crystal Lake Acquisition). In accordance with the transaction agreement, $60,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Non-current Security deposits 5,799 Property and equipment 820,000 Operating lease right-of-use 554,830 1,380,629 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 554,830 Net assets acquired 825,799 Goodwill 400,000 Purchase price 1,225,799 This acquisition was an opportunity for the Company to increase its presence in Illinois. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $1.0 million and income before tax of approximately $0.2 million to the Company’s consolidated results for the twelve months ended December 31, 2020. In our estimation, this acquisition would have contributed revenue of approximately $1.1 million and income before tax of approximately $0.2 million to the Company’s consolidated results for the twelve months ended December 31, 2019. iii) On April 1, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Davie, Florida, for cash consideration of $450,000 (Davie Acquisition). In accordance with the transaction agreement, $50,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller on October 1, 2019. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows: $ Assets acquired Non-current Property and equipment 170,000 Operating lease right-of-use 427,558 597,558 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 427,558 Net assets acquired 170,000 Goodwill 280,000 Purchase price 450,000 This acquisition was an opportunity for the Company to increase its economies of scale across Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $0.4 million and loss before tax of approximately $41 thousand to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $0.5 million in revenue and $54 thousand in loss before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $247.6 million and $13.2 million, respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. iv) On April 15, 2019, the Company announced that it had, through a subsidiary, entered into purchase agreements to acquire 27 imaging centres (Florida – 21 and Georgia – 6) operated under ADG, The Imaging Centers of West Palm and Elite Radiology of Georgia. All of these centres were managed by ADG’s management team. On May 31, 2019, the Company announced the closing of these acquisitions. Pursuant to the purchase agreements, the Company acquired all of the issued and outstanding equity interests of ADG Acquisition Holdings, Inc., TIC Acquisition Holdings, LLC and SFL Radiology Holdings, LLC (the ADG Acquisitions). The total purchase price (excluding earn-out) earn-out The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. Intangible assets include covenant not to compete, trade name and license arrangements. A deferred tax liability was assumed as part of the net assets acquired in the ADG Acquisitions. $ Assets acquired Current assets Cash 3,585,672 Accounts receivable 19,418,814 Prepaid expenses 269,012 23,273,498 Non-current Property and equipment 11,508,940 Intangible assets 5,870,000 Operating lease right-of-use 16,912,896 34,291,836 57,565,334 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 5,634,661 Non-current Deferred tax liability 422,056 Operating lease liabilities (right-of-use) 16,912,896 17,334,952 22,969,613 Net assets acquired 34,595,721 Goodwill 195,937,055 Purchase price (cash and shares) 215,784,755 Purchase price (ADG Acquisition – earn-out 14,748,021 These acquisitions were an opportunity for the Company to increase its economies of scale across Florida and enter the Georgia market. The goodwill assessed on acquisition, expected to not be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of these acquisitions have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, these acquisitions contributed revenue of approximately $42.5 million and income before tax of approximately $17.4 million to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from these acquisitions had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $72.6 million in revenue and $29.7 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $277.5 million and $25.5 million, respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. v) On May 31, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Deltona, Florida, for a cash consideration of $648,387 (Deltona Acquisition). The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows: $ Assets acquired Non-current Property and equipment 295,000 Operating lease right-of-use 154,136 449,136 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 57,880 Non-current Operating lease liabilities (right-of-use) 154,136 212,016 Net assets acquired 237,120 Goodwill 411,267 Purchase price 648,387 This acquisition was an opportunity for the Company to increase its economies of scale across Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $1.9 million and income before tax of approximately $0.6 million to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $3.2 million in revenue and $1.0 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $248.8 million and $13.6 million, respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. vi) On August 16, 2019, the Company acquired, through a subsidiary, five outpatient diagnostic imaging centres in El Paso, Texas, for cash consideration of $11 million (El Paso Acquisition). The cash purchase price was decreased during 2020 by approximately $16 thousand due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete. 2020 2019 $ $ Assets acquired Current assets Accounts receivable 1,275,726 1,275,726 Prepaid expenses 19,789 19,789 1,295,515 1,295,515 Non-current Property and equipment 3,922,481 3,922,481 Operating lease right-of-use 3,683,989 3,683,989 Intangible assets 720,000 720,000 9,621,985 9,621,985 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,174,040 1,024,631 Non-current Operating lease liabilities (right-of-use) 3,683,989 3,683,989 4,858,029 4,708,620 Net assets acquired 4,763,956 4,913,365 Goodwill 6,220,153 6,086,635 Purchase price 10,984,109 11,000,000 This acquisition was an opportunity for the Company to increase its economies of scale in Texas. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $5.3 million and income before tax of approximately $1.1 million to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $14.0 million in revenue and $3.0 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $256.1 million and $15.0 million, respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. vii) On October 4, 2019, the Company acquired, through a subsidiary, three outpatient diagnostic imaging centres in West Palm Beach, Florida, for cash consideration of approximately $18 million (West Palm Beach Acquisition). The cash purchase price was decreased during 2020 by approximately $0.1 million due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete. 2020 2019 $ $ Assets acquired Current assets Accounts receivable 2,085,491 2,085,491 Prepaid expenses 90,454 90,454 2,175,945 2,175,945 Non-current Security deposits 9,000 9,000 Property and equipment 2,432,234 2,432,234 Operating lease right-of-use 13,625,521 13,625,521 Intangible assets 1,080,000 1,080,000 19,322,700 19,322,700 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,404,268 1,311,471 Non-current Finance leases 587,434 587,434 Operating lease liabilities (right-of-use) 13,625,521 13,625,521 15,617,223 15,524,426 Net assets acquired 3,705,477 3,798,274 Goodwill 14,064,109 14,071,312 Purchase price 17,769,586 17,869,586 This acquisition was an opportunity for the Company to increase its economies of scale in Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $4.8 million and income before tax of approximately $0.4 million to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $19.8 million in revenue and $1.6 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $262.4 million and $14.4 million, respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition.

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
Property and Equipment	4 Property and equipment 2020 $ 2019 $ Medical equipment 85,588,228 75,665,771 Equipment under finance leases 23,168,355 14,971,916 Leasehold improvements 19,360,169 17,393,839 Furniture and fixtures 1,479,320 1,088,236 Office equipment 211,032 214,612 Computer equipment 240,919 194,770 Total property and equipment – cost 130,048,023 109,529,144 Less: Accumulated depreciation (50,118,449) (33,590,554) Total property and equipment – net 79,929,574 75,938,590 As at December 31, 2020, the equipment under finance leases had a net book value of $14,981,186 (2019 - $9,404,765). Depreciation expense for the twelve months ended December 31, 2020 was $17,769,948 (2019 – $13,705,653). As part of ongoing operations, during the twelve months ended December 31, 2020, the Company had net disposals of $1,779,626 (2019 – $1,030,006). The loss on these disposals was $1,549,295 (2019 - $931,356) and is included in the consolidated statements of operations and comprehensive income (loss) in the expense category “financial instruments revaluation and other gains (losses)” and in note 20.

Intangible Assets

Intangible Assets	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	5 Intangible assets Covenants not to compete $ Software costs $ Trade name $ License Arrange- $ Total $ Cost Balance – January 1, 2019 1,127,917 241,855 3,283,000 - 4,652,772 Additions - 2,675 - - 2,675 Business acquisitions (note 3) 2,010,000 - 4,540,000 1,120,000 7,670,000 Balance – December 31, 2019 3,137,917 244,530 7,823,000 1,120,000 12,325,447 Additions - 5,412 - - 5,412 Balance – December 31, 2020 3,137,917 249,942 7,823,000 1,120,000 12,330,859 Accumulated amortization Balance – January 1, 2019 323,611 119,225 568,584 - 1,011,420 Amortization 594,307 31,973 1,124,601 130,666 1,881,547 Balance – December 31, 2019 917,918 151,198 1,693,185 130,666 2,892,967 Amortization 868,572 32,648 1,564,599 224,000 2,689,819 Balance – December 31, 2020 1,786,490 183,846 3,257,784 354,666 5,582,786 Net book value December 31, 2019 2,219,999 93,332 6,129,815 989,334 9,432,480 December 31, 2020 1,351,427 66,096 4,565,216 765,334 6,748,073 Weighted average remaining amortization period (years) 1.5 2.0 2.8 3.5 2.5 For the twelve months ended December 31, 2020, the Company identified no impairment indicators and hence, there was no impairment of intangible assets. Estimated aggregate amortization expense for definite-lived intangible assets for each of the next five years ended December 31 is as follows: 2021 $ 2,710,490 2022 2,190,685 2023 1,275,099 2024 570,223 2025 1,125 Total 6,747,622

Goodwill

Goodwill	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	6 Goodwill The carrying amounts of goodwill at the beginning and end of the current and previous periods are set out below. 2020 $ 2019 $ Balance – Beginning of period 358,802,534 147,120,852 Adjustments (note 3) 126,315 (5,104,587) Business acquisitions (note 3) 1,674,764 216,786,269 Balance – End of period 360,603,613 358,802,534 The carrying amount of goodwill attributed to each reporting unit was as follows: 2020 $ 2019 $ Florida 256,270,533 255,002,971 Northeast 3,569,801 3,569,801 Texas 92,803,338 92,669,821 Other 7,959,941 7,559,941 360,603,613 358,802,534 The fair value of each reporting unit was estimated by use of the income approach. The methodology used to test impairment is classified as Level 3 per the fair value hierarchy described in note 16. The fair value for a reporting unit is determined by discounting five-year cash flow projections (cash flows beyond the five-year period are extrapolated using perpetuity growth rates). These projections reflect management’s expectations based on past experience and future estimates of operating performance. The discount rates are applied to the cash flow projections and are derived from the weighted average cost of capital for each reporting unit or group of reporting units. The Company’s discount rates are based on market rates of return, debt to equity ratios, and certain risk premiums, among other things. The perpetuity growth rates are based on expected economic conditions and a general outlook for the industry. An impairment charge is recognized to the extent that the carrying amount exceeds the fair value. No impairment charges have arisen as a result of the reviews performed as at October 1, 2020. Reasonably possible changes in key assumptions would not cause the recoverable amount of goodwill to fall below the carrying amount. As there were no indicators of impairment for any of the reporting units, management has not updated any of the other impairment calculations as at December 31, 2020.

Accounts Payable and Accrued Li

Accounts Payable and Accrued Liabilities	12 Months Ended
	Dec. 31, 2020
Payables and Accruals [Abstract]
Accounts Payable and Accrued Liabilities	7 Accounts payable and accrued liabilities The accounts payable and accrued liabilities are as follows: 2020 $ 2019 $ Accounts payable 20,400,949 21,707,080 Accrued other expenses 10,034,409 2,602,292 Accrued payroll expenses 3,797,784 1,952,853 34,233,142 26,262,225

Earn-Out Liability (ADG Acquisi

Earn-Out Liability (ADG Acquisition)	12 Months Ended
	Dec. 31, 2020
Business Combinations [Abstract]
Earn-Out Liability (ADG Acquisition)	8 Earn-out 2020 $ 2019 $ ADG Acquisition – earn-out 4,688,553 14,834,067 Less: Current portion of ADG Acquisition – earn-out (4,688,553 ) (7,529,962) Non-current earn-out - 7,304,105 A portion of the purchase price payable in respect of the ADG Acquisitions in 2019, specifically for SFL Radiology Holdings, LLC (Georgia business), was subject to an earn-out earn-out The value of the ADG Acquisition – earn-out earn-out earn-out earn-out earn-out

Lease liabilities

Lease liabilities	12 Months Ended
	Dec. 31, 2020
Leases [Abstract]
Lease liabilities	9 Lease liabilities Finance The information pertaining to finance lease liabilities on the consolidated balance sheet is as follows: 2020 $ 2019 $ Finance lease liabilities 15,573,586 8,415,404 Less: Current portion of finance lease liabilities (3,264,806 ) (1,789,995) Non-current 12,308,780 6,625,409 The components of finance lease cost recognized in the consolidated statement of operations and comprehensive income (loss) are as follows: 2020 $ 2019 $ Amortization expense for equipment under finance leases 2,927,249 1,794,673 Interest expense on finance lease liabilities 637,191 296,603 Finance lease cost 3,564,440 2,091,276 Undiscounted cash flows for finance leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 3,910,052 2022 3,768,295 2023 3,347,796 2024 2,749,931 2025 1,893,323 Thereafter 1,762,745 Total minimum lease payments 17,432,142 Less: Amount of lease payments representing interest (1,858,556) Present value of future minimum lease payments 15,573,586 Less: Current portion of finance lease liabilities (3,264,806) Non-current 12,308,780 The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-finance leases (years) 4.9 4.8 Weighted average discount rate-finance leases 4.6% 5.1% Supplemental cash flow information related to finance leases is as follows: 2020 $ 2019 $ Operating cash flows from finance leases 637,191 296,603 Financing cash flows from finance leases 1,524,548 904,193 Right-of-use 8,816,902 5,309,686 Operating The information pertaining to operating lease liabilities on the consolidated balance sheet is as follows: 2020 $ 2019 $ Operating lease liabilities 132,299,312 129,049,990 Less: Current portion of operating lease liabilities (9,345,656 ) (9,276,298 ) Non-current 122,953,656 119,773,692 The components of operating lease cost recognized in the consolidated statement of operations and comprehensive income (loss) are as follows: 2020 $ 2019 $ Operating lease cost 20,624,622 18,040,356 Variable lease cost 4,109,277 3,478,748 Short-term lease cost 246,785 170,366 Total operating lease cost 24,980,684 21,689,470 Undiscounted cash flows for operating leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 18,380,966 2022 18,075,153 2023 17,224,588 2024 16,355,082 2025 15,659,482 Thereafter 137,590,224 Total minimum lease payments 223,285,495 Less: Amount of lease payments representing interest (90,986,183 ) Present value of future minimum lease payments 132,299,312 Less: Current portion of operating lease liabilities (9,345,656 ) Non-current 122,953,656 The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-operating leases (years) 12.7 14.1 Weighted average discount rate-operating leases 7.4% 7.1% Supplemental cash flow information related to operating leases is as follows: 2020 $ 2019 $ Operating cash flows from operating leases 17,672,048 15,660,780 Right-of-use 13,800,876 137,301,712

Senior loans payable

Senior loans payable	12 Months Ended
	Dec. 31, 2020
Debt Disclosure [Abstract]
Senior Loans Payable	10 Senior loans payable The 2025 Loans and Wesley Chapel Loan are collectively referred to as the Senior Loans . The minimum annual principal payments with respect to the Senior Loans (face value) as at December 31, 2020 are as follows: $ 2021 405,698 2022 426,454 2023 296,356 2024 - 2025 400,000,000 401,128,508 2025 Senior Notes On November 2, 2020, the Company closed its previously announced offering of $400 million of aggregate principal amount of 7.0% senior secured notes due November 1, 2025 (the 2025 Senior Notes). The net proceeds from this offering were used to repay in full the Amended May 2019 Term Loans, Revolving Facility and net derivative financial instrument liabilities, in accordance with respective contracts, and to pay related financing fees and expenses. The balance of approximately $19 million was retained as cash. The 2025 Senior Notes are fully and unconditionally guaranteed, jointly and severally, by the Company and each of its direct or indirect wholly owned subsidiaries, including the Revenue Practices, and secured against substantially all of the assets of the Company and the guarantors pari passu 2020 $ 2019 $ 2025 Senior Notes 388,906,059 - Less: Current portion - - 388,906,059 - The 2025 Senior Notes indenture provides for the following (capitalized terms used below in this note and not defined elsewhere in these notes have the respective meanings given to them in the 2025 Senior Notes indenture): • Payments The principal payment is due at maturity on November 1, 2025. Interest is accrued and payable every six • Restrictive The 2025 Senior Notes indenture restricts the Company’s ability to, among other things: incur certain additional indebtedness and issue preferred stock; make certain distributions, investments and other restricted payments; sell certain assets; agree to any restrictions on the ability of Subsidiaries (including the Revenue Practices) to make payments to the Company; create certain liens; merge, consolidate or sell substantially all of the Company’s assets; and enter into certain transactions with affiliates. These covenants are subject to exceptions and qualifications and many of these covenants will not be applicable during any period when the 2025 Senior Notes have an investment grade rating. • Financial There are no maintenance financial covenants. There are incurrence-based covenants related to the restrictive covenants noted above. The Company is in compliance with the covenants and has no events of default under this indenture as at December 31, 2020. • Events of default Events of default under the 2025 Senior Notes indenture include, among others, failure to pay principal of or interest on the 2025 Senior Notes and certain final judgments when due (subject to appropriate periods and conditions); failure to comply, within appropriate period, with obligations under certain covenants or any provision in the 2025 Senior Notes indenture; certain events of bankruptcy or insolvency and if any Guarantee by a Significant Subsidiary is held in a judicial proceeding to be unenforceable or invalid. The occurrence of an event of default would permit the Trustee or holders of at least 25% of the 2025 Senior Notes to declare all of the 2025 Senior Notes together with unpaid accrued interest, to be immediately due and payable and to exercise other default remedies. 2020 Revolving Facility Concurrently with the closing of the 2025 Senior Notes, the Company entered into a new revolving credit agreement (the 2020 Revolving Credit Agreement) with a US financial institution, as administrative and collateral agent, and other financial institutions, as lenders, to provide a senior secured revolving credit facility in an aggregate principal amount of $55 million (the 2020 Revolving Facility, and together with 2025 Senior Notes, the 2025 Loans), with sub-limits pari passu The availability of borrowings under the 2020 Revolving Facility is subject to customary terms and conditions. The 2020 Revolving Facility was undrawn at November 2, 2020 (it is considered a Level 3 liability as described in note 16). The issuance costs related to this credit facility were approximately $2.0 million (including approximately $0.9 million related to the prior Revolving Facility since the settlement of the Revolving Facility was considered debt modification for accounting purposes). These costs are included in security deposits and other assets in the balance sheet and are being amortized to interest expense over the term of the 2020 Revolving Facility. The annual commitment fee related to the 2020 Revolving Facility is capped at 0.5% of the aggregate principal amount of $55 million. As at December 31, 2020, the 2020 Revolving Facility had a face value and amortized cost balance of $nil (2019 - $nil). 2020 $ 2019 $ 2020 Revolving Facility - - The 2020 Revolving Credit Agreement provides for the following (capitalized terms used below in this note and not defined elsewhere in these notes have the respective meanings given to them in the 2020 Revolving Credit Agreement): • Interest The interest rates payable on the 2020 Revolving Facility are as follows: (i) each Eurodollar Rate Loan bears interest on the outstanding principal amount at Adjusted Eurodollar Rate (effectively, LIBOR) plus the Applicable Rate; (ii) each Base Rate Loan bears interest on the outstanding principal amount at the Base Rate (the highest of (a) the Prime Rate, (b) the Federal Reserve Bank of New York Rate plus 0.5% and (c) one-month • Restrictive In addition to certain covenants, the 2020 Revolving Credit Agreement places limits on the Company’s ability to declare dividends or redeem or repurchase capital stock (including options or warrants), prepay, redeem or purchase debt, incur liens and engage in sale-leaseback transactions, make loans and investments, incur additional indebtedness, amend or otherwise alter debt and other material agreements, engage in mergers, acquisitions and asset sales, enter into transactions with affiliates and alter the business the Company and the Subsidiaries currently conduct. • Financial The 2020 Revolving Credit Agreement contains a financial covenant related to a leverage ratio that is tested on the last day of any fiscal quarter (commencing with the fiscal quarter ending March 31, 2021) only if on the last day of any such fiscal quarter, the outstanding amount under the 2020 Revolving Facility (excluding certain letter of credit obligations) exceeds 30% of the total commitment under the 2020 Revolving Facility of $55 million. Borrowings under the 2020 Revolving Facility were nil as at December 31, 2020 and therefore did not exceed 30% of the total commitment under the 2020 Revolving Facility. As a result, the Company is in compliance with the financial covenant. No event of default under the 2020 Revolving Credit Agreement had occurred as at December 31, 2020. • Events of default Events of default under the 2020 Revolving Credit Agreement include, among others, failure to pay principal of or interest on the 2020 Revolving Facility when due, failure to pay any fee or other amount due, failure of any loan party to comply with any covenants or agreements in the loan documents (subject to applicable grace periods and/or notice requirements), a representation or warranty contained in the loan documents is incorrect or misleading in a material respect when made, events of bankruptcy and a change of control. The occurrence of an event of default would permit the lenders under the 2020 Revolving Credit Agreement to declare all amounts borrowed, together with accrued interest and fees, to be immediately due and payable and to exercise other default remedies. Amended May 2019 Loans On June 2, 2020, the Company entered into an amendment to its senior credit agreement which amended the credit agreement signed effective May 31, 2019 (such amended credit agreement, the Amended May 2019 Credit Agreement). Under the terms of the Amended May 2019 Credit Agreement, the Company received in May 2019 a term loan A and term loan B (Term Loan A, Term Loan B and collectively, Term Loans) of $66,000,000 and $266,000,000, respectively (face value) and a revolving credit facility of $50,000,000, which was increased to $69,000,000 on June 2, 2020 (the Revolving Facility, and together with the Term Loans, the Amended May 2019 Loans). In addition, among other things, the amendment adjusted Akumin’s leverage and fixed charge ratios for the four quarters ended March 31, 2021, providing the Company with greater flexibility in its financial ratio covenants. Sixteen million dollars of the Term Loan A was subject to a delayed draw, which was drawn by the Company in October 2019 to partly finance the West Palm Beach Acquisition. The term of the Amended May 2019 Loans is five years from May 31, 2019. The Amended May 2019 Loans can be increased by an additional $100,000,000 subject to certain conditions. The proceeds of the Term Loans were used during 2019 to settle in accordance with the respective contracts, the Syndicated Loans for $112,482,181, the principal outstanding under Subordinated Note and related accrued and unpaid interest for $1,596,250, partly finance the ADG Acquisitions and Deltona Acquisition in May 2019 and pay related debt issuance costs. On May 31, 2019, management determined the fair value of the Amended May 2019 Loans to be their face value of $319,300,000 net of debt issuance costs of approximately $14.8 million and a debt modification accounting adjustment of approximately $1.0 million related to the settlement of the Syndicated Loans. The fair value of the Amended May 2019 Loans was determined based on management’s estimation of assumptions that market participants would use in pricing similar liabilities (it is considered a Level 3 liability as described in note 16). As at December 31, 2019, the Amended May 2019 Loans had a balance of approximately, $338.5 million. In June 2020, the amendment costs related to the Amended May 2019 Credit Agreement were netted against the balance of the Amended May 2019 Loans. The above-noted amendment to the senior credit agreement in June 2020 was considered debt modification for accounting purposes. On November 2, 2020, the Amended May 2019 Loans and related accrued and unpaid interest and costs were settled completely in accordance with the credit agreement, for approximately $364 million using proceeds of the 2025 Senior Notes. This settlement of the May 2019 Term Loans was considered debt extinguishment for accounting purposes and a loss of approximately $18 million was recognized in the consolidated statements of operations and comprehensive income (loss). The settlement of the Revolving Facility was considered debt modification for accounting purposes and a cost of approximately $0.9 million was added to the issuance costs of the 2020 Revolving Facility. 2020 $ 2019 $ Term Loan A and Revolving Facility - 87,824,000 Term Loan B - 250,710,995 Less: Current portion - (3,320,000 ) - 335,214,995 Effective November 14, 2018, the Company entered into a derivative financial instrument contract with a financial institution in order to mitigate interest rate risk under the variable interest rate Syndicated Loans (which were settled in 2019). The derivative financial instrument is an interest rate cap rate of 3.75% (LIBOR) per annum on a notional amount of 50% of the face value of the Syndicated Term Loan ($50,000,000 as at November 14, 2018). The termination date of this arrangement is August 31, 2021. The cost of this derivative financial instrument was $155,000. The Company has not designated this interest rate cap agreement as a cash flow hedge for accounting purposes. On November 2, 2020, this derivative financial instrument was terminated and settled completely for $nil consideration (2019 asset - $597) and a loss for the year-ended December 31, 2020 of $597 was recognized in the consolidated statements of operations and comprehensive income (loss). In addition, effective July 31, 2019, the Company entered into a derivative financial instrument, an interest rate collar contract (further amended in November 2019 and February 2020), with a financial institution in order to mitigate interest rate risk under the variable interest rate Term Loans. This derivative financial instrument has an underlying notional amount of 100% of the face value of Term Loan B ($266,000,000 as at July 31, 2019) and a termination date of July 31, 2022 with (i) a cap rate of 3.00% (LIBOR) per annum, and (ii) a floor rate of 1.1475% (LIBOR) per annum. There was no upfront cost of this derivative financial instrument. The Company has not designated this interest rate cap agreement as a cash flow hedge for accounting purposes. On November 2, 2020, this derivative financial instrument was terminated and settled completely for $4,805,000 (2019 liability - $951,702) and a loss for the year-ended December 31, 2020 of approximately $3.9 million was recognized in the consolidated statements of operations and comprehensive income (loss) in the line “Financial instruments revaluation and other (gains) losses”. During the year ended December 31, 2020, the Company incurred interest expense of $1,301,854 (2019 - $nil) with respect to this derivative financial instrument. The interest expense was paid on a monthly basis. The settlement payment with respect to this derivative financial instrument in the cashflow statement is included in the line “Loan repayments”. Wesley Chapel Loan As part of the Rose Acquisition in 2018, the Company, through a subsidiary, assumed a senior secured loan (Wesley Chapel Loan) of $2,000,000 (face value) as of August 15, 2018 to finance the purchase of equipment and related installation at a clinic location around Tampa Bay, Florida. It has an annual interest rate of 5.0%, matures on August 15, 2023 and has monthly repayments of $37,742. The Wesley Chapel Loan was recognized at fair value of $1,908,456 on August 15, 2018 using an effective interest rate. The fair value was determined based on management’s estimation of assumptions that market participants would use in pricing similar liabilities (it is considered a Level 3 liability as described in note 16). As at December 31, 2020, the Wesley Chapel Loan had an amortized cost balance of approximately, $1.1 million. 2020 $ 2019 $ Wesley Chapel Loan 1,079,684 1,447,327 Less: Current portion (405,698 ) (385,952 ) 673,986 1,061,375 Subject to the provisions described below, the minimum annual principal payments with respect to the Wesley Chapel Loan (face value) are as follows: $ 2021 405,698 2022 426,454 2023 296,356 1,128,508 The Wesley Chapel Loan provides for the following terms: • Interest 5.0%. • Payments Monthly payments (principal and interest) of $37,742. The minimum principal payment schedule for the Wesley Chapel Loan is noted herein. • Termination August 15, 2023. • Restrictive covenants In addition to certain covenants, the Wesley Chapel Loan limits the Company’s ability to dispose of the assets of Akumin Corp., which is the guarantor to the Wesley Chapel Loan. • Financial covenants None. • Events of default Events of default under the Wesley Chapel Loan include, among others, failure to repay the Wesley Chapel Loan in full at maturity, or to pay any other sum due hereunder within ten days of the date when the payment is due, events of insolvency or disposition of all or substantially all of the assets related to the Rose Acquisition. The occurrence of an event of default would permit the lender to declare all amounts borrowed, together with accrued interest and fees, to be immediately due and payable and to exercise other default remedies. The Company has no events of default under the Wesley Chapel Loan as at December 31, 2020. • Security The Company has granted first security interest to the lender over the equipment and leasehold improvements acquired using the proceeds of the Wesley Chapel Loan.

Subordinated notes payable -

Subordinated notes payable - earn-out	12 Months Ended
	Dec. 31, 2020
Debt Disclosure [Abstract]
Subordinated notes payable - earn-out	11 Subordinated notes payable – earn-out 2020 $ 2019 $ Subordinated note – earn-out - 184,485 As part of the Tampa Acquisition, Akumin FL entered into a subordinated 6% note and security agreement with the seller’s secured lender on May 11, 2018 (the Subordinated Note and Subordinated Note Lender, respectively) with a face value of $1,500,000 and a term of four years. The Subordinated Note was recognized at fair value of $1,490,932 on May 11, 2018 using an effective interest rate. The fair value was determined based on management’s estimation of assumptions that market participants would use in pricing similar liabilities (it is considered a Level 3 liability as described in note 16; this liability was subsequently settled as noted below). In accordance with the terms of the Subordinated Note, the Company used part of the proceeds of the Term Loans to settle the principal outstanding under the Subordinated Note on May 31, 2019, together with accrued and unpaid interest, for $1,596,250 (face value of $1,500,000 and accrued interest of $96,250). The Company also recorded a fair value loss of $6,830 on the extinguishment of the Subordinated Note, which was reflected in the 2019 consolidated statements of operations and comprehensive income (loss). According to the Subordinated Note, the Company was subject to an earn-out Earn-out) Earn-out a) The Subordinated Note – Earn-out Earn-out Earn-out b) The Subordinated Note – Earn-out Earn-out c) If Subordinated Note – Earn-out Earn-out Earn-out d) The maximum aggregate amount of the Subordinated Note – Earn-out Earn-out The value of Subordinated Note – Earn-out Earn-out Earn-out Earn-out Earn-out Earn-out

Capital stock and warrants

Capital stock and warrants	12 Months Ended
	Dec. 31, 2020
Equity [Abstract]
Capital stock and warrants	12 Capital stock and warrants The authorized share capital of the Company consists of an unlimited number of voting common shares, with no par value. Common shares Warrants RSUs Total Number Amount $ Number Amount $ Number Amount $ Number Amount $ January 1, 2019 62,371,275 123,746,423 1,249,512 1,742,910 1,120,656 2,671,147 64,741,443 128,160,480 Issuance (i) 6,250,000 23,437,500 - - - 1,559,418 6,250,000 24,996,918 RSUs and warrants exercised 1,219,653 4,813,632 (436,497) (569,733) (783,156) (2,932,753) - 1,311,146 Warrants expired - - (288,015) (438,798) - - (288,015) (438,798) December 31, 2019 69,840,928 151,997,555 525,000 734,379 337,500 1,297,812 70,703,428 154,029,746 Issuance (i) - - - - 14,138 - 14,138 RSUs settled 337,500 1,311,950 - - (337,500) (1,311,950) - - Warrants expired - - (525,000) (734,379) - - (525,000) (734,379) December 31, 2020 70,178,428 153,309,505 - - - - 70,178,428 153,309,505 (i) RSU issuance amount includes stock-based compensation and costs related to RSUs during the period of the consolidated financial statements. RSUs are issued in accordance with the Company’s RSU Plan, which entitles a holder of one RSU to receive one common share of the Company. RSUs are assigned a value based on the market value of the common shares of the Company on the grant date (or the nearest working day prior to the grant date). Such value is classified as stock-based compensation over the vesting period for all RSUs awarded to employees or the Board. During the twelve months ended December 31, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company. a) During the three months ended March 31, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) During March 2017, the Company issued 300,825 warrants to purchase common shares on a 1:1 basis at an exercise price of $2.30 per common share. These warrants were scheduled to expire on March 10 and 17, 2019. During the three months ended September 30, 2018, 120,330 of these warrants were exercised into common shares. The remaining 180,495 warrants were exercised into common shares prior to expiry during the three months ended March 31, 2019. ii) The Board had granted 315,000 RSUs to certain employees of the Company between January 1 and March 12, 2018. Fifty percent of these RSUs vested between January 1 and March 12, 2019 in accordance with the terms of the RSU Plan and 25,000 of these vested RSUs were settled for common shares prior to March 31, 2019. b) During the three months ended June 30, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) The Company issued approximately $23 million in equity (6,250,000 common shares at $3.75 per share, the closing price as of May 31, 2019) to certain sellers in connection with the ADG Acquisitions. ii) During August 2017, the Company issued 512,004 warrants to purchase common shares on a 1:1 basis at an exercise price of $3.50 per common share. The expiry date for these warrants was August 8, 2019. During the three months ended June 30, 2019, 256,002 of these warrants were exercised into common shares. iii) The Board had granted 315,000 RSUs to certain employees of the Company between January 1 and March 12, 2018. Fifty percent of these RSUs vested between January 1 and March 12, 2019 in accordance with the terms of the RSU Plan and 25,000 of these vested RSUs were settled for common shares prior to March 31, 2019. The remaining 132,500 of these vested RSUs were settled for common shares prior to June 30, 2019. c) During the three months ended September 30, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) During August 2017, the Company issued 512,004 warrants to purchase common shares on a 1:1 basis at an exercise price of $3.50 per common share. The expiry date for these warrants was August 8, 2019. During the three months ended June 30, 2019, 256,002 of these warrants were exercised into common shares. The remaining 256,002 of these warrants were not exercised into common shares and expired on August 8, 2019. d) During the three months ended December 31, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) During November 2017, the Company issued 32,013 warrants to purchase common shares on a 1:1 basis at an exercise price of $3.50 per common share. These warrants were not exercised into common shares and expired on November 14, 2019. ii) The Board had granted 1,611,316 RSUs to certain employees of the Company and members of the Board on November 15, 2017. In accordance with the terms of the RSU Plan, 50% of these RSUs vested and were settled for common shares in November 2018. Of the remaining RSUs, 600,656 RSUs vested and were settled for common shares on November 18, 2019 and the remaining RSUs vested on January 1, 2020 in accordance with the terms of the RSU Plan. iii) The Board had granted 315,000 RSUs to certain employees of the Company between January 1 and March 12, 2018. Fifty percent of these RSUs vested between January 1 and March 12, 2019 and were subsequently settled for common shares in accordance with the terms of the RSU Plan. Of the remaining RSUs: I. Twenty-five thousand RSUs were settled for common shares on October 1, 2019 in accordance with the terms of the RSU Plan; and II. Ninety thousand RSUs vested on January 1, 2020 and 42,500 RSUs vested in March 2020. During the twelve months ended December 31, 2020, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company. a) During the three months ended March 31, 2020, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) As at December 31, 2019, the Company had 337,500 RSUs outstanding. All of these RSUs vested between January 1, 2020 and March 12, 2020. 285,000 of these RSUs were settled for common shares on March 12, 2020 in accordance with the terms of the RSU Plan. As at March 31, 2020, the Company had 52,500 RSUs outstanding. b) During the three months ended June 30, 2020, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) As at March 31, 2020, the Company had 52,500 RSUs outstanding. All of these RSUs vested between January 1, 2020 and March 12, 2020 and they were settled for common shares in accordance with the terms of the RSU Plan as follows. 10,000 of these RSUs were settled for common shares in April 2020 and the remaining RSUs were settled for common shares in June 2020. As at June 30, 2020 and through the balance of fiscal 2020, the Company had no RSUs outstanding. The Company granted RSUs in March 2021 as discussed in note 26. ii) During May 2018, the Company had issued 525,000 warrants to purchase common shares on a 1:1 basis at an exercise price of $4.00 per common share. These warrants were not exercised into common shares and expired on May 2, 2020. c) During the three months ended September 30, 2020 and three months ended December 31, 2020, there were no equity issuances or exercise or expiry of equity related instruments at the Company. The stock-based compensation related to RSUs, recognized in the consolidated statements of operations and comprehensive income (loss) for the twelve months ended December 31, 2020 was $14,137 (2019 – $1,559,418). The stock-based compensation related to stock options is noted in note 15.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	13 Income taxes The reconciliation of income tax expense (benefit) computed at the Canadian federal statutory rate to income tax expense (benefit) is as follows: 2020 $ 2019 $ Income attributable to common shareholders before income taxes (26,148,454 ) 13,163,526 Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%) (6,929,340 ) 3,488,334 Increase (decrease) in income taxes resulting from Stock-based compensation 396,528 942,013 State franchise tax, net of federal benefit 212,684 219,538 US tax rate differential 603,264 (400,948 ) Return to provision adjustment 345,299 1,389,866 Other (205,656 ) (164,747 ) Valuation allowance (173,849 ) (1,738,508 ) Income tax expense (benefit) (5,751,070 ) 3,735,548 U.S. Federal current tax expense (benefit) U.S. State current tax expense (benefit) (320,815 ) 1,643,043 Canadian current tax expense (benefit) U.S. Federal deferred tax expense (benefit) (4,433,785 ) 2,688,571 U.S. State deferred tax expense (benefit) (996,470 ) (596,066 ) Canadian deferred tax expense (benefit) Total income tax expense (benefit) (5,751,070 ) 3,735,548 The Company’s effective tax rate for the year ended December 31, 2020 was 22.0% (2019 – (28.38%)). The tax rate is affected by recurring items, such as tax rates in the United States and the relative amounts of income earned in this jurisdiction, which management expects to be fairly consistent in the near term. It is also affected by discrete items that may occur in any given year but are not consistent from year to year. Deferred income taxes reflect the net tax effects of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amount used for income tax purposes. The Company’s deferred tax assets and liabilities are made up of the following components: 2020 $ 2019 $ Deferred tax assets Lease liabilities 31,615,510 33,474,270 Net operating losses 15,745,126 3,692,446 163(j) carryforward 5,934,846 1,458,105 Debt issuance costs 2,419,687 4,412,375 Capital acquisition costs 2,011,450 779,367 Other 3,409,797 9,430,097 Total deferred tax assets 61,136,416 53,246,660 Less: Valuation allowance (Canada) (2,634,364 ) (2,800,607 ) Net deferred tax assets 58,502,052 50,446,053 Deferred tax liabilities Right-of-use (30,360,097 ) (32,907,312 ) Fixed assets (14,973,077 ) (12,400,551 ) Goodwill (10,664,325 ) (8,392,326 ) Other (3,331,119 ) (3,002,684 ) Total deferred tax liabilities (59,328,618 ) (56,702,873 ) Net deferred tax liabilities (826,566 ) (6,256,820 ) Management regularly assesses the available positive and negative evidence to estimate whether sufficient future taxable income will be generated to permit use of the existing deferred tax assets in Canada and the US. Based on management’s assessment of the future profitability of the Company’s Canadian operations, as at December 31, 2020, a valuation allowance of $2,634,364 (2019 – $2,800,607) has been recorded to recognize only the portion of the deferred tax asset that is more likely than not to be realized. Management’s assessment of the future profitability of the Company’s US operations has determined that the deferred tax assets related to the US operations are more likely than not to be realized and a valuation allowance against these existing deferred tax assets should not currently be required. The amount of the deferred tax assets is considered realizable, however, it could be adjusted if estimates of future taxable income during the carry-forward period are reduced or increased. The Company has made a significant investment in its US operations and asserts that earnings from such operations will be indefinitely reinvested in the US. Therefore; determination of unrecognized deferred tax liability on outside basis differences is not practicable at this time. The Company has operating loss carry-forwards of $68,755,558 (2019 – $16,226,326), of which $19,742,894 begin to expire in 2036. Of these loss-carryforwards, $49,012,664 do not expire but are subject to utilization restrictions. The Company also has a Section 163(j) interest expense carryforward of $24,670,177 (2019 - $1,007,969) which does not expire but is subject to utilization restrictions. Tax years 2017-2019 and 2016-2019 remain subject to examination by the tax authorities in the US and Canada, respectively.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and contingencies	14 Commitments and contingencies The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. With respect to these matters, the management evaluates the developments on a regular basis and accrues a liability when it believes a loss is probable and the amount can be reasonably estimated. We believe that the amount or any estimable range of reasonably possible or probable loss will not, either individually or in the aggregate, have a material adverse effect on our business and consolidated financial statements. However, the outcome of these matters is inherently uncertain. Therefore, if one or more of these matters were resolved against the Company for amounts in excess of management’s expectations, our results of operations and financial condition, including in a particular reporting period in which any such outcome becomes probable and estimable, could be materially adversely affected. Commencing during Q1 2020 and continuing through the present and beyond, a pandemic relating to the novel coronavirus known as COVID-19 Imaging centers are healthcare facilities and as such are generally considered an essential service and expected to continue to operate during any epidemic or pandemic. However, there is potential that actions taken by government, referring physicians or individual actions, in response to containment or avoidance of this coronavirus could impact a patient’s ability or decision to seek imaging services at a given time which could have a significant impact on volume at our imaging centers leading to temporary or prolonged staff layoffs, reduced hours, closures and other cost containment efforts. Further, there is potential that certain services which are not urgent and can be deferred without significant harm to a patient’s health may be delayed, either by the Company in response to local laws or good public health practice or voluntarily by the patient. In addition, there is potential that the outbreak of the coronavirus could impact supply chains, including the Company’s supply of personal protective equipment, and lead to personnel shortages, each of which could impact the ability of the Company to safely perform imaging services. It is also possible that social distancing efforts and sanitization and decontamination procedures could cause delays in the performance of imaging services. Depending on the severity and duration of the COVID-19

Stock-Based Compensation –

Stock-Based Compensation – Options	12 Months Ended
	Dec. 31, 2020
Share-based Payment Arrangement [Abstract]
Stock-based compensation – options	15 Stock-based compensation – options The Company operates an equity-settled, stock options based payment compensation plan, under which the Company pays equity instruments of the Company as consideration in exchange for services received. The fair value of the grant of options is recognized in the consolidated statements of operations and comprehensive income (loss) as an expense. The total amount to be expensed is determined by reference to the fair value of the options granted. The total expense is recognized over the vesting period, which is the period over which all of the service vesting conditions are to be satisfied. The maximum number of common shares reserved for issuance, in the aggregate, under the Company’s option plan (and under any other share compensation arrangements of the Company) is 10% of the aggregate number of common shares which are outstanding from time to time. As at December 31, 2020, this represented 7,017,842 (2019 – 6,984,092) common shares. Number of stock options Weighted average exercise price $ Aggregate grant date fair value $ Weighted average remaining contractual term (years) Outstanding – January 1, 2019 4,213,268 $2.18 $5,353,785 7.0 Cancelled (100,000) 3.74 (146,790) - Expired - - - - Exercised - - - - Granted 1,664,852 3.29 2,391,393 - Outstanding – December 31, 2019 5,778,120 2.47 7,598,388 6.3 Cancelled (18,000) 3.74 (26,422) - Expired - - - - Exercised - - - - Granted - - - - Outstanding – December 31, 2020 5,760,120 $2.47 $7,571,966 5.3 Exercisable at December 31, 2020 3,978,218 $2.03 $4,990,924 5.2 During the twelve months ended December 31, 2020, the Company did not grant any stock options. During the twelve months ended December 31, 2019, the Company granted approximately 1.7 million stock options on November 18, 2019, to purchase common shares on a 1:1 basis with an exercise price of $3.29 per share. The fair value of the stock options granted during 2019 was determined to be $2.4 million. These options will vest over a three-year period from the date of issue (34%, 33% and 33% per year, respectively) and have an expiry date of seven years from the date of issue. The fair value of the stock options granted during the twelve months ended December 31, 2019 was estimated to be $1.4364 per option using the Black-Scholes option pricing model based on the following assumptions. The Company granted stock options in March 2021 as discussed in note 26. Date of options grant November 18, 2019 Underlying stock price 3.29 Exercise price 3.29 Term of options (years) 7.0 Volatility of underlying stock price 40% Expected dividend yield on underlying stock nil Annual risk free interest rate 1.48% At December 31, 2020, 1.8 million options were outstanding but not yet exercisable with a weighted average exercise price of $3.46, weighted average remaining contractual term of 5.5 years and weighted average grant date fair value of approximately $1.4 million. At December 31, 2019, 3.0 million options were outstanding but not yet exercisable with a weighted average exercise price of $3.49, weighted average remaining contractual term of 6.4 years and weighted average grant date fair value of approximately $2.2 million. During the twelve months ended December 31, 2020, the weighted average grant date fair value of stock options that: a) vested was $0.9 million (2019 – $0.9 million); and b) were cancelled was $26 thousand (2019 – $0.1 million). The total grant date fair value of stock options that vested during the twelve months ended December 31, 2020 was $1.8 million (2019 – $1.7 million). During the twelve months ended December 31, 2020, the Company recorded a total stock-based options compensation expense of approximately $2,069,777 (2019 – $1,995,347). The total compensation cost related to unvested options awards not yet recognized is approximately $1,089,614 (2019 – $3,185,813) and will be recognized over a remaining vesting period of 1.88 years (2019 – 2.88 years).

Risk Management Arising From Fi

Risk Management Arising From Financial Instruments	12 Months Ended
	Dec. 31, 2020
Fair Value Disclosures [Abstract]
Risk management arising from financial instruments	16 Risk management arising from financial instruments The carrying value of cash, accounts receivable, accounts payable and accrued liabilities and leases (current portion) approximates their fair value given their short-term nature. The carrying value of the non-current non-current 2020 $ 2019 $ 2025 Senior Notes 424,016,044 - Amended May 2019 loans payable - 360,596,500 Wesley Chapel Loan payable 1,122,400 1,483,830 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 951,105 429,826,997 378,049,987 Financial instruments recorded at fair value on the consolidated balance sheets are classified using a fair value hierarchy that reflects the significance of the inputs used in making the measurements. The fair value hierarchy has the following levels: • Level 1 – quoted prices (unadjusted) in active markets for identical assets or liabilities Inputs are unadjusted quoted prices in active markets for identical assets or liabilities. Pricing inputs are based on quoted prices in active markets for identical assets or liabilities that the reporting entity has the ability to access at the measurement date. For securities, the valuations are based on quoted prices of the securities that are readily and regularly available in an active market, and accordingly, a significant degree of judgment is not required. As at December 31, 2020, the Company did not have any financial assets or liabilities measured at fair value under the Level 1 category. • Level 2 – inputs other than quoted prices included in Level 1 that are observable for the asset or liability; either directly (i.e., as prices) or indirectly (i.e., derived from prices) Pricing inputs are based on quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model based valuation techniques for which all significant assumptions are observable in the market or can be corroborated by observable market data for substantially the full term of the assets or liabilities. The estimated fair value of the liabilities that are recognized at fair value, and subsequently measured at amortized cost, are determined using Level 2 inputs primarily related to comparable market prices. As at December 31, 2020, the 2025 Senior Notes and derivative financial instruments were measured at fair value under the Level 2 category on recognition. The derivative financial instruments are subsequently remeasured at fair value under the Level 2 category. • Level 3 – inputs for the asset or liability that are not based on observable market data (unobservable inputs) Pricing inputs are generally unobservable for the assets or liabilities and include situations where there is little, if any, market activity for the investment. The inputs into the determination of fair value require management’s judgment or estimation of assumptions that market participants would use in pricing the assets or liabilities. The fair values are therefore determined using model based techniques that include option pricing models, discounted cash flow models, and similar techniques. The Amended May 2019 Loans, Wesley Chapel Loan, Subordinated Note – Earn-out, Earn-out Earn-out Earn-out Earn-out Earn-out The following table summarizes information regarding the change in carrying value of the Company’s financial instruments carried at fair value. Derivative Subordinated Earn-out $ ADG Earn-out $ January 1, 2019 (16,014) 169,642 - Issuance - - 14,748,022 Financial instruments revaluation loss (gain) Realized - - - Unrealized 967,119 14,843 86,045 December 31, 2019 951,105 184,485 14,834,067 Payment (4,805,000) (200,000) (4,688,553) Financial instruments revaluation loss (gain) Realized 3,853,895 15,515 (2,728,480) Unrealized - - (2,728,481) December 31, 2020 - - 4,688,553 There were no transfers between levels during the twelve months ended December 31, 2020 and the twelve months ended December 31, 2019. A transfer is made between levels during the period that a financial instrument meets the relevant criteria. Financial instruments are classified into one of the following categories: amortized cost, fair value through profit or loss and fair value through other comprehensive income. The following table summarizes information regarding the carrying value of the Company’s financial instruments: 2020 $ 2019 $ Cash 44,395,988 23,388,916 Accounts receivable 91,126,923 82,867,225 Financial assets measured at amortized cost 135,522,911 106,256,141 Accounts payable and accrued liabilities 34,233,142 26,262,225 Short-term portion of senior loans payable 405,698 3,705,952 Short-term portion of leases 12,610,462 11,066,293 Long-term portion of senior loans payable 389,580,046 336,276,370 Long-term portion of leases 135,262,436 126,399,101 Financial liabilities measured at amortized cost 572,091,784 503,709,941 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 951,105 Measured at fair value through profit or loss 4,688,553 15,969,657 Credit risk The Company has a diverse mix of payers, including private, managed care, capitated and government payers. Credit risk arises from the potential a counterparty will fail to perform its obligations. The Company is exposed to credit risk from customers. The Company grants credit to its customers in the normal course of business. The consolidated financial statements take into account an allowance for bad debts. The Company is exposed to credit risk from its customers but the concentration of the risk is minimized because of the large customer base and its dispersion across different payers. During the year, the Company may have deposits with financial institutions that exceed Federal Deposit Insurance Corporation limits. As at December 31, 2020, the Company had cash of $44,395,988 (2019 – $23,388,916) and accounts receivable of $91,126,923 (2019 – $82,867,225). Collectability of the receivables is actively monitored on an ongoing basis and an allowance or a write-off write-off non-individual COVID-19 COVID-19 Currency risk Currency risk is the risk to the Company’s earnings that arises from fluctuations in foreign exchange rates and the degree of volatility of those rates. In the normal course of business, the Company may enter into foreign exchange contracts with financial institutions to hedge the value of foreign currency denominated assets. Gains and losses arising from these contracts offset the losses and gains from the underlying hedged transactions. As at December 31, 2020 and December 31, 2019, the Company did not enter into any foreign exchange contracts that would expose the Company to currency risk. Interest rate risk Interest rate risk is the risk the fair value or future cash flows of a financial instrument will fluctuate because of changes in market interest rates. Changes in lending rates can cause fluctuations in interest payments and cash flows. The Company does not use derivative financial instruments to alter the effects of this risk, except as noted in note 10. As at December 31, 2020, the Company’s variable interest rate debt only related to the 2020 Revolving Facility (note 10), which was not drawn during 2020. The following table shows the Company’s exposure to interest rate risk and the effects on comprehensive income for the twelve months ended December 31, 2020 and 2019 of a 1% increase or decrease in the variable interest rates. 2020 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (n/a as settled in November 2020) - - - 2019 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (originated in May 2019) 338,534,995 1,180,247 (1,979,043 ) Syndicated Loans (n/a as settled in May 2019) - - - 338,534,995 1,180,247 (1,979,043 )

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2020
Related Party Transactions [Abstract]
Related Party Transactions	17 Related party transactions The Company transacts with key individuals including directors and executive management who have authority and responsibility to plan, direct, and control the activities of the Company. On November 1, 2020, the Company acquired an MRI machine from an entity in which an officer of a subsidiary of the Company holds a significant interest for $400,000, which has been paid in full. The MRI machine is to be installed in one of the Company’s diagnostic imaging facilities in Florida. There are no ongoing contractual or other commitments resulting from the transaction. On February 8, 2018, Akumin Corp. entered into a contract with the President and Chief Executive Officer, Executive Vice President and Chief Operating Officer and Chief Financial Officer and Corporate Secretary (collectively, the Pledgors) to loan an aggregate of $500,000 in connection with the purchase by such Pledgors of a total of 142,857 common shares of the Company from certain selling security holders of PMI, pursuant to the terms of a put and call option agreement made as of August 9, 2017 between Z Strategies Inc., a company controlled by the President and Chief Executive Officer, and certain selling security holders of PMI. This loan charged interest at 6% per annum and was payable on maturity at February 8, 2021. During 2019, the Pledgors completely paid off this loan and accrued interest.

New Accounting Standards

New Accounting Standards	12 Months Ended
	Dec. 31, 2020
Accounting Standards Update and Change in Accounting Principle [Abstract]
New accounting standards	18 New accounting standards The standards and interpretations that are issued, but not yet effective, up to the date of issuance of the Company’s consolidated financial statements are disclosed below. The Company intends to adopt these standards, if applicable, when they become effective. ASU 2018-15, 350-40) In August 2018, the FASB issued ASU 2018-15, Intangibles – Goodwill and Other – Internal-Use 350-40) internal-use internal-use ASU 2016-13, In June 2016, the FASB issued ASU 2016-13 , Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments

Basic And Diluted Income (Loss)

Basic And Diluted Income (Loss) Per Share	12 Months Ended
	Dec. 31, 2020
Earnings Per Share [Abstract]
Basic and diluted income (loss) per share	19 Basic and diluted income (loss) per share 2020 $ 2019 $ Net income (loss) attributable to common shareholders (20,397,384 ) 9,427,978 Weighted average common shares outstanding Basic 70,101,618 66,528,051 Add: additional shares issuable upon exercise of employee stock options, warrants and restricted share units 2,066,938 Diluted 70,101,618 68,594,989 Net income (loss) per share Basic and diluted (0.29 ) 0.14 Employee stock options warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,664,231

Financial Instruments Revaluati

Financial Instruments Revaluation And Other Gains (Losses)	12 Months Ended
	Dec. 31, 2020
Financial Instruments Revaluation And Other Gains Losses [Abstract]
Financial instruments revaluation and other gains (losses)	20 Financial instruments revaluation and other gains (losses) a) Operational Financial instruments revaluation and other gains (losses) 2020 $ 2019 $ Gain (loss) on revaluation of ADG Acquisition – Earn-out 5,456,961 (86,045 ) Loss on disposal of property and equipment (1,549,295 ) (931,356 ) (3,907,666 ) (1,017,401 ) b) Other Financial instruments revaluation and other gains (losses) 2020 $ 2019 $ Loss on debt revaluation (note 10) (18,278,845 ) (829,208 ) Loss on revaluation of derivatives (note 10) (3,853,895 ) (967,119 ) Other gains (losses) 53,995 (9,489 ) (22,078,745 ) (1,805,816 )

Revenue Information

Revenue Information	12 Months Ended
	Dec. 31, 2020
Revenue from Contract with Customer [Abstract]
Revenue information	21 Revenue information 2020 $ 2019 $ Commercial 163,893,988 173,056,345 Medicare 28,449,283 28,849,651 Medicaid 7,889,878 7,421,432 Attorney 24,271,130 14,784,804 Workers comp 9,960,660 10,569,156 Other patient revenue 9,516,244 10,160,012 Service fees - net of allowances and discounts 243,981,183 244,841,400 Other revenue (management and ancillary fees and government grants) 7,301,666 2,594,903 251,282,849 247,436,303

Cost Of Operations, Excluding D

Cost Of Operations, Excluding Depreciation And Amortization	12 Months Ended
	Dec. 31, 2020
Cost Of Operations Excluding Depreciation And Amortization [Abstract]
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization	22 Cost of operations, excluding depreciation and amortization 2020 $ 2019 $ Employee compensation 84,038,371 85,899,654 Reading fees 37,817,457 35,243,843 Rent and utilities 30,203,346 26,332,049 Third party services and professional fees 21,706,906 19,084,397 Administrative 12,875,606 12,459,281 Medical supplies and other 11,161,702 8,783,377 197,803,388 187,802,601

Settlement Costs And Other (Rec

Settlement Costs And Other (Recoveries)	12 Months Ended
	Dec. 31, 2020
Business Litigation Settlement Costs And Other Recoveries [Abstract]
Settlement costs and other (recoveries)	23 Settlement costs and other (recoveries) During the twelve months ended December 31, 2020, the Company experienced net settlement costs of approximately $2.3 million (2019 – settlement recoveries of $1.9 million) mainly related to the following items. i) Approximately, $0.8 million related to a settlement of a government investigation that relates predominantly to historical reimbursements paid under federal healthcare programs to subsidiaries or the Revenue Practices. This settlement was reached in January 2021. ii) Approximately $1.1 million comprised of a few settlement costs related to four vendors.

Non-Controlling Interests

Non-Controlling Interests	12 Months Ended
	Dec. 31, 2020
Noncontrolling Interest Items [Abstract]
Non-controlling interests	24 Non-controlling As part of the Texas Acquisition in 2017, certain of PMI’s subsidiaries acquired were non-wholly non-wholly non-controlling non-controlling non-controlling The Company currently holds effective ownership interests in the following non-wholly Ownership interest Entity 2020 2019 % % Phoenix Imaging, LLC 60 60 Preferred Imaging of Amarillo, LLC 57 57

CARES Act

CARES Act	12 Months Ended
	Dec. 31, 2020
Coronavirus Aid Relief And Economic Security Act [Abstract]
Coronavirus Aid Relief And Economic Security Act [Text Block]	25 CARES Act i) During April 2020, the Company received approximately $1.1 million in grant under the first appropriation made by the HHS to Medicare providers pursuant to the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Subsequently, in December 2020, the Company received an additional grant from the HHS of approximately $4.1 million. Additional grants may be available to the Company through subsequent appropriations under this program. The Company applied for these grants after determining that it was eligible to do so. Also, the Company has incurred expenses and experienced loss of revenue that are eligible to be reimbursed under these grants. The grants received are recorded in the consolidated statements of operations comprehensive income (loss) in the category “Other revenue”. ii) During April 2020, the Company received approximately $3.1 million of accelerated Medicare payments under the expanded Accelerated and Advance Payments Program from Centers for Medicare & Medicaid Service (CMS). These payments are currently required to be applied to claims beginning one year after their receipt through the adjudication of Medicare claims over a future period. These payments to the Company are recorded in the consolidated balance sheets in the category “Accounts payable and accrued liabilities” until earned. iii) The CARES Act allows employers to defer the deposit and payment of the employer’s share of Social Security taxes. As of December 31, 2020, such taxes were approximately $2.7 million and approximately $1.3 million are recorded in the consolidated balance sheets in the category “Accrued payroll taxes” and the remaining balance in the category “Accounts payable and accrued liabilities”.

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2020
Subsequent Events [Abstract]
Subsequent Events [Text Block]	26 Subsequent events i) The Company announced on February 11, 2021 that it completed its private offering of $75 million aggregate principal amount of additional 7.00% senior secured notes due November 2025 (the “New Notes”). The New Notes were offered as additional notes under the same indenture as the previously issued 2025 Senior Notes and will be treated as a single series with the 2025 Senior Notes. The Company expects to use the net proceeds from this offering for future acquisitions, with any unused proceeds to be used for working capital and other general corporate purposes, which may include reducing debt. The New Notes are fully and unconditionally guaranteed, jointly and severally, on a senior secured basis by each wholly owned subsidiary of the Company, including the Revenue Practices and the guarantors. ii) Effective March 1, 2021, the Company completed a common equity investment in an artificial intelligence business as part of a private placement offering for approximately $4.6 million. The target develops artificial intelligence aided software programs for use in medical businesses, including outpatient imaging services of the sort provided by the Company. As a result of the investment, a previous investment in a convertible note instrument issued by the target to the Company in May 2020 converted for common equity. The Company’s total investment is estimated to be valued at approximately $8.0 million and represents a 34.5% interest in the target. In addition, the Company holds share purchase warrants which, subject to the occurrence of certain events, and the payment of approximately $0.4 million, would entitle the Company to acquire a further 2.4% interest in the target’s common equity. iii) On March 9, 2021, the Board granted 645,000 RSUs and 70,000 options to certain employees and consultants of the Company pursuant to the Company’s RSU plan and stock option plan, respectively, in connection with the Company’s equity bonus awards. In addition, 84,032 RSUs were granted to non-executive 5-day

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2020
Accounting Policies [Abstract]
Principles of Consolidation	Principles of consolidation The consolidated financial statements include all of the accounts of the Company, the Subsidiaries and the Revenue Practices. All intercompany transactions and balances have been eliminated on consolidation.
Variable Interest Entities	Variable interest entities In accordance with the FASB’s ASC Topic 810, Consolidation As a result of the financial relationship established between the Company and the Revenue Practices through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, The Company has a variable interest in a single purpose entity in Texas which operates an imaging center. The Company also has a variable interest in certain operations of an imaging center of another Texas entity. In both cases, the Company is not a primary beneficiary of the variable interest since it does not have any equity ownership in these entities nor does it have the power to direct the activities of either of these entities that most significantly impact the entities’ economic performance. Rather, in both cases, the Company is entitled to a management fee based upon written agreements in exchange for certain agreed upon management services. The assets and liabilities and revenue and expenses of these entities are not included in the consolidated financial statements of the Company.
Functional and Reporting Currency and Foreign Currency Translation	Functional and reporting currency and foreign currency translation The functional and reporting currency of the Company, the Subsidiaries and the Revenue Practices is US dollars. Monetary assets and liabilities denominated in foreign currencies are translated into US dollars at the rates of exchange prevailing at the consolidated balance sheet dates. Non-monetary
Cash	Cash Cash includes cash on hand and cash held with banks.
Property and Equipment	Property and equipment Property and equipment are recorded at cost and are depreciated over their estimated useful lives using the straight line method, as follows: Medical equipment and equipment under finance leases six years Computer and office equipment four to five years Furniture and fittings nine years Leasehold improvements over term of lease Expenditures for maintenance and repairs are charged to operations as incurred. Operating lease right-of-use
Intangible Assets	Intangible assets The Company classifies intangible assets, obtained through acquisitions or developed internally, as definite lived. Intangible assets consist of software costs, trade name, license arrangements and covenants not to compete; these intangible assets are recorded at cost and are amortized over their estimated useful lives, using the straight line method, as follows: Software costs, trade name and license arrangements five to six years Covenant not to compete over term of contract The Company reviews the appropriateness of the amortization period related to the definite lived intangible assets annually.
Goodwill	Goodwill In January 2017, FASB issued Accounting Standards Update (ASU) 2017-04, Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment (ASU 2017-04) 2017-04 2017-04 2017-04 2017-04. Goodwill is recognized as the fair value of the consideration transferred, less the fair value of the net identifiable assets acquired and liabilities assumed, as at the acquisition date. Subsequent to initial recognition, goodwill is measured at cost less accumulated impairment losses. Goodwill acquired in business combinations is allocated to reporting units that are expected to benefit from the synergies of the combination. The determination of reporting units and the level at which goodwill is monitored requires judgment by management. The Company’s reporting units generally represent individual business units below the level of the Company’s operating segment. Goodwill is tested annually for impairment as at October 1 or whenever indicators of impairment are present by comparing the carrying amount of the reporting units against its fair value.
Impairment of Long-Lived Assets	Impairment of long-lived assets The Company reviews long-lived assets for impairment when events or changes in circumstances indicate the carrying amount of an asset may not be recoverable. If any indication exists, the Company estimates the recoverable amount. The Company assesses the recoverability of the assets based on the undiscounted future cash flows expected from the use and eventual disposition of the asset. If the carrying amount of the asset is determined not to be recoverable, a write-down to fair value is recorded. Fair values are determined based on quoted market values, discounted cash flows, or external appraisals, as applicable. Long-lived assets to be disposed of are reported at the lower of carrying amount or fair value less costs to sell. The amount of the impairment charge is calculated as the excess of the asset’s carrying value over its fair value, which generally represents the discounted future cash flows from that asset or in the case of assets we expect to sell, at fair value less costs to sell.
Segment Reporting	Segment reporting Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. The Company has one reportable segment, which is outpatient diagnostic imaging services.
Revenue Recognition	Revenue recognition On January 1, 2019, the Company adopted ASU 2014-09, Revenue from Contracts with Customers (Topic 606) The Company adopted ASC 606 with a full retrospective application. As a result, at the adoption of ASC 606, the majority of what was previously classified as the provision for bad debts in the consolidated statement of operations is now reflected as implicit price concessions (as defined in ASC 606) and therefore included as a reduction to revenue. Net service fee revenue consists of net patient fees received from various payers and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. It primarily comprises fees for the use of the Company’s diagnostic imaging equipment and provision of medical supplies. Service fee revenue is recorded during the period in which the Company’s performance obligations are satisfied, based on the estimated collectible amounts from the patients and third party payers. The Company’s performance obligations are satisfied when services are rendered to the patient. Since the gap between payment and delivery of services to patients is generally expected to be less than one year, the Company does not adjust the service fee revenue for a significant financing component, as a practical expedient. Third party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, attorneys, and employers. Estimates of contractual allowances and the transaction price are based on the terms specified in the related contractual agreements, negotiated rates and historical and expected payment patterns. The Company estimates its expected reimbursement for patients based on the applicable contract terms and negotiated rates. The Company believes its review process enables it to identify instances on a timely basis where such estimates need to be revised. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third party payers, management fees, government grants and fees for other services provided to third parties. Revenue is recorded during the period in which the Company’s performance obligations under the contract are satisfied by the Company. For 2020, the Company received grants from the U.S. Health and Human Services (HHS). Such grants are outside the scope of ASC 606 and are further discussed in note 25. ASC 606 applies a single model for recognizing revenue from contracts with customers. It requires revenue to be recognized in a manner that depicts the transfer of promised goods or services to a customer and at an amount that reflects the consideration expected to be received in exchange for transferring those goods or services. This is achieved by applying the following five steps: i) identify the contract with a customer; ii) identify the performance obligation in the contract; iii) determine the transaction price; iv) allocate the transaction price to the performance obligations in the contract; and v) recognize revenue when (or as) the entity satisfies a performance obligation.
Earnings per Share	Earnings per share Basic earnings per common share (EPS) is calculated by dividing the net earnings available to common shareholders by the weighted average number of common shares outstanding during the year. Diluted EPS is calculated by adjusting the net earnings available to common shareholders and the weighted average number of common shares outstanding for the effects of all dilutive instruments.
Income Taxes	Income taxes Income tax expense comprises current and deferred tax. Income tax is recognized in the consolidated statements of operations and comprehensive income (loss). Current income tax expense represents the amount of income taxes payable based on tax law that is enacted at the reporting date and is adjusted for changes in estimates of tax expense recognized in prior periods. A current tax liability or asset is recognized for income taxes payable, or paid but recoverable, in respect of all periods to date. The Company uses the asset and liability method of accounting for income taxes. Under this method, deferred tax assets and liabilities are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. A deferred tax asset is recognized for unused tax losses, tax credits and deductible temporary differences, to the extent that it is more likely than not that future taxable income will be available to utilize such amounts. Deferred tax assets are reviewed at each reporting date and are adjusted to the extent that it is no longer probable that the related tax benefits will be realized. When it appears more likely than not that deferred taxes will not be realized, a valuation allowance is recorded to reduce the deferred tax asset to its estimated realizable value. For net deferred tax assets, estimates of future taxable income are considered in determining whether net deferred tax assets are more likely than not to be realized. Deferred tax assets and liabilities are offset when they relate to income taxes levied by the same tax authority and the Company intends to settle its current tax assets and liabilities on a net basis. The Company reports a liability for unrecognized tax benefits resulting from uncertain tax positions taken or expected to be taken in a tax return. The Company recognizes interest and penalties, if any, related to unrecognized tax benefits in income tax expense.
Financial Instruments	Financial instruments Financial assets (such as accounts receivable) and liabilities (such as accounts payable, accrued liabilities, leases and loans) at amortized cost are initially recognized at fair value, and subsequently are carried at amortized cost (using the effective interest rate method) less any impairment. Any premium or discount between amortized cost and fair value is amortized to the consolidated statements of operations and comprehensive income (loss). Derivative financial instruments and earn-outs are initially recognized and subsequently measured at fair value. No derivatives have been designated as a cash flow hedge under ASC 815, Derivatives and Hedging
Leases	Leases In February 2016, the FASB issued ASU 2016-02. 2016-02’s 2016-02 2016-02 2016-02 On January 1, 2019, the Company recorded right-of-use The Company’s operating lease portfolio primarily consists of real estate leases for its imaging centres and corporate offices. A smaller portion consists of medical and office equipment leases. The Company elected to use the package of practical expedients offered in the transition guidance that allows management not to reassess lease identification, lease classification and initial direct costs. The Company also elected to use the accounting policy practical expedients by class of underlying asset to (i) combine associated lease and non-lease right-of-use Operating lease liabilities were recorded as the present value of remaining lease payments not yet paid for the lease term discounted using the incremental borrowing rate associated with each lease. Operating lease right-of-use right-of-use Variable components of lease payments fluctuating with a future index or rate are estimated at lease commencement based on the index or rate at lease commencement. If the payments change as the result of a change in an index or rate subsequent to lease commencement, the difference is recognized in the income statement in the period in which the change occurs. Variable payments for maintenance such as common area maintenance costs and taxes, are not included in determining lease payments and are expensed as incurred. Most of the Company’s leases do not contain implicit borrowing rates, and therefore to measure lease liabilities, the Company used its incremental borrowing rates at the later of the lease commencement date or January 1, 2019. Lease liabilities will be remeasured when there is a significant change in the lease contracts.
Warrants	Warrants Financial instruments issued by the Company are classified as equity only to the extent they do not meet the definition of a financial liability or financial asset. The Company has issued warrants that are convertible into common stock; these warrants are classified as equity instruments.
Restricted Share Units	Restricted share units Restricted share units (RSUs) are issued in accordance with the Company’s RSU Plan, which entitles a holder of one RSU to receive one common share of the Company. RSUs are assigned a value based on the market value of the common shares of the Company on the grant date (or the nearest working day prior to the grant date). Such value is classified as stock-based compensation over the vesting period for all RSUs awarded to employees or the Board (note 12). For RSUs awarded to non-employees
Stock-Based Compensation	Stock-based compensation The Company’s stock-based compensation consists of stock options, which are described in note 15 and RSUs, which are discussed in note 12. Each tranche of a share option award is considered a separate award with its own vesting period and recorded at fair value on the date of grant. The fair value of each tranche is measured at the date of grant using the Black-Scholes option pricing model. Compensation expense is recognized over the tranche’s vesting period based on the number of awards expected to vest by increasing contributed surplus. Any consideration paid upon the exercise of stock options is credited to common stock and the related fair value of those stock options is transferred from the contributed surplus to common stock.
Business Combinations	Business combinations In January 2019, the Company adopted FASB issued ASU 2017-01, Clarifying the Definition of a Business (2017-01) The Company accounts for business combinations using the acquisition accounting method. The total purchase price is allocated to the assets acquired and liabilities assumed based on fair values as at the date of acquisition. Goodwill as at the acquisition date is measured as the excess of the aggregate of the consideration transferred and the amount of any non-controlling non-controlling
Changes in Non-Controlling Interests	Changes in non-controlling The Company treats transactions with non-controlling non-controlling non-controlling
Contingencies	Contingencies Loss contingency is an existing condition, situation, or set of circumstances involving uncertainty as to possible loss to an entity that will ultimately be resolved when one or more future events occur or fail to occur. The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. In assessing loss contingencies related to legal proceedings that are pending against the Company or unasserted claims that may result in such proceedings, the Company, with assistance from its legal counsel, evaluates the perceived merits of any legal proceedings or unasserted claims as well as the perceived merits of the amount of relief sought or expected to be sought. Accrued legal costs for legal contingencies are recorded when they are probable and estimable.
Accounts Receivable	Accounts receivable Accounts receivable are generally non-interest non-individual COVID-19 COVID-19 Accounts receivable are considered to be in default when customers have failed to make the contractually required payments when due. Implicit price concessions are recorded as a reduction in revenue with an offsetting amount reducing the carrying value of the receivable. When a receivable is considered uncollectible, the receivable is written off against the allowance for bad debts account. In the fourth quarter of 2020, due to slow down in collections of receivables, the Company changed its estimates of the implicit price concessions related to its customers, primarily based on historical experience of collections impacted by the pandemic and the integration of diagnostic imaging centers acquired in 2018 and 2019. The result of this change in estimate resulted in an increase as compared to the year ended December 31, 2019 to the cumulative implicit price concessions for outstanding receivables by approximately $12.3 million ($9.4 million net of tax) in the year ended 2020, or $0.13 per share (basic and diluted) for the three and twelve months ended December 31, 2020.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2020
Accounting Policies [Abstract]
Summary of Property and Equipment and Estimated Useful Lives Using the Straight Line Method	Property and equipment are recorded at cost and are depreciated over their estimated useful lives using the straight line method, as follows: Medical equipment and equipment under finance leases six years Computer and office equipment four to five years Furniture and fittings nine years Leasehold improvements over term of lease
Summary of Definite Lived Intangible Assets Useful Life	The Company classifies intangible assets, obtained through acquisitions or developed internally, as definite lived. Intangible assets consist of software costs, trade name, license arrangements and covenants not to compete; these intangible assets are recorded at cost and are amortized over their estimated useful lives, using the straight line method, as follows: Software costs, trade name and license arrangements five to six years Covenant not to compete over term of contract

Business Combinations (Tables)

Business Combinations (Tables)	12 Months Ended
	Dec. 31, 2020
Coral Springs [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	i) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Coral Springs, Florida, for cash consideration of approximately $2.1 million (Coral Springs Acquisition). In accordance with the transaction agreement, $100,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Current assets Prepaid expenses 32,961 Non-current Security deposits 368,601 Property and equipment 412,400 Operating lease right-of-use 2,427,618 3,241,580 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 2,427,618 Net assets acquired 813,962 Goodwill 1,274,764 Purchase price 2,088,726
Crystal Lake [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	ii) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Crystal Lake, Illinois, for cash consideration of approximately $1.2 million (Crystal Lake Acquisition). In accordance with the transaction agreement, $60,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Non-current Security deposits 5,799 Property and equipment 820,000 Operating lease right-of-use 554,830 1,380,629 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 554,830 Net assets acquired 825,799 Goodwill 400,000 Purchase price 1,225,799
Davie Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	iii) On April 1, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Davie, Florida, for cash consideration of $450,000 (Davie Acquisition). In accordance with the transaction agreement, $50,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller on October 1, 2019. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows: $ Assets acquired Non-current Property and equipment 170,000 Operating lease right-of-use 427,558 597,558 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 427,558 Net assets acquired 170,000 Goodwill 280,000 Purchase price 450,000
ADG Acquisitions [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. Intangible assets include covenant not to compete, trade name and license arrangements. A deferred tax liability was assumed as part of the net assets acquired in the ADG Acquisitions. $ Assets acquired Current assets Cash 3,585,672 Accounts receivable 19,418,814 Prepaid expenses 269,012 23,273,498 Non-current Property and equipment 11,508,940 Intangible assets 5,870,000 Operating lease right-of-use 16,912,896 34,291,836 57,565,334 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 5,634,661 Non-current Deferred tax liability 422,056 Operating lease liabilities (right-of-use) 16,912,896 17,334,952 22,969,613 Net assets acquired 34,595,721 Goodwill 195,937,055 Purchase price (cash and shares) 215,784,755 Purchase price (ADG Acquisition – earn-out 14,748,021
Deltona Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	v) On May 31, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Deltona, Florida, for a cash consideration of $648,387 (Deltona Acquisition). The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows: $ Assets acquired Non-current Property and equipment 295,000 Operating lease right-of-use 154,136 449,136 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 57,880 Non-current Operating lease liabilities (right-of-use) 154,136 212,016 Net assets acquired 237,120 Goodwill 411,267 Purchase price 648,387
El Paso Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	vi) On August 16, 2019, the Company acquired, through a subsidiary, five outpatient diagnostic imaging centres in El Paso, Texas, for cash consideration of $11 million (El Paso Acquisition). The cash purchase price was decreased during 2020 by approximately $16 thousand due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete. 2020 2019 $ $ Assets acquired Current assets Accounts receivable 1,275,726 1,275,726 Prepaid expenses 19,789 19,789 1,295,515 1,295,515 Non-current Property and equipment 3,922,481 3,922,481 Operating lease right-of-use 3,683,989 3,683,989 Intangible assets 720,000 720,000 9,621,985 9,621,985 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,174,040 1,024,631 Non-current Operating lease liabilities (right-of-use) 3,683,989 3,683,989 4,858,029 4,708,620 Net assets acquired 4,763,956 4,913,365 Goodwill 6,220,153 6,086,635 Purchase price 10,984,109 11,000,000
West Palm Beach Acquisition [Member]
Business Acquisition [Line Items]
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows	vii) On October 4, 2019, the Company acquired, through a subsidiary, three outpatient diagnostic imaging centres in West Palm Beach, Florida, for cash consideration of approximately $18 million (West Palm Beach Acquisition). The cash purchase price was decreased during 2020 by approximately $0.1 million due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete. 2020 2019 $ $ Assets acquired Current assets Accounts receivable 2,085,491 2,085,491 Prepaid expenses 90,454 90,454 2,175,945 2,175,945 Non-current Security deposits 9,000 9,000 Property and equipment 2,432,234 2,432,234 Operating lease right-of-use 13,625,521 13,625,521 Intangible assets 1,080,000 1,080,000 19,322,700 19,322,700 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,404,268 1,311,471 Non-current Finance leases 587,434 587,434 Operating lease liabilities (right-of-use) 13,625,521 13,625,521 15,617,223 15,524,426 Net assets acquired 3,705,477 3,798,274 Goodwill 14,064,109 14,071,312 Purchase price 17,769,586 17,869,586

Property and Equipment (Tables

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
Summary of Detailed Information of Property and Equipment	2020 $ 2019 $ Medical equipment 85,588,228 75,665,771 Equipment under finance leases 23,168,355 14,971,916 Leasehold improvements 19,360,169 17,393,839 Furniture and fixtures 1,479,320 1,088,236 Office equipment 211,032 214,612 Computer equipment 240,919 194,770 Total property and equipment – cost 130,048,023 109,529,144 Less: Accumulated depreciation (50,118,449) (33,590,554) Total property and equipment – net 79,929,574 75,938,590

Intangible Assets (Tables)

Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Summary of Intangible Assets	Covenants not to compete $ Software costs $ Trade name $ License Arrange- $ Total $ Cost Balance – January 1, 2019 1,127,917 241,855 3,283,000 - 4,652,772 Additions - 2,675 - - 2,675 Business acquisitions (note 3) 2,010,000 - 4,540,000 1,120,000 7,670,000 Balance – December 31, 2019 3,137,917 244,530 7,823,000 1,120,000 12,325,447 Additions - 5,412 - - 5,412 Balance – December 31, 2020 3,137,917 249,942 7,823,000 1,120,000 12,330,859 Accumulated amortization Balance – January 1, 2019 323,611 119,225 568,584 - 1,011,420 Amortization 594,307 31,973 1,124,601 130,666 1,881,547 Balance – December 31, 2019 917,918 151,198 1,693,185 130,666 2,892,967 Amortization 868,572 32,648 1,564,599 224,000 2,689,819 Balance – December 31, 2020 1,786,490 183,846 3,257,784 354,666 5,582,786 Net book value December 31, 2019 2,219,999 93,332 6,129,815 989,334 9,432,480 December 31, 2020 1,351,427 66,096 4,565,216 765,334 6,748,073 Weighted average remaining amortization period (years) 1.5 2.0 2.8 3.5 2.5
Summary of Finite-Lived Intangible Assets Net Amortization Expense	For the twelve months ended December 31, 2020, the Company identified no impairment indicators and hence, there was no impairment of intangible assets. Estimated aggregate amortization expense for definite-lived intangible assets for each of the next five years ended December 31 is as follows: 2021 $ 2,710,490 2022 2,190,685 2023 1,275,099 2024 570,223 2025 1,125 Total 6,747,622

Goodwill (Tables)

Goodwill (Tables)	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The carrying amounts of goodwill at the beginning and end of the current and previous periods are set out below. 2020 $ 2019 $ Balance – Beginning of period 358,802,534 147,120,852 Adjustments (note 3) 126,315 (5,104,587) Business acquisitions (note 3) 1,674,764 216,786,269 Balance – End of period 360,603,613 358,802,534
Schedule of Carrying amount of goodwill	The carrying amount of goodwill attributed to each reporting unit was as follows: 2020 $ 2019 $ Florida 256,270,533 255,002,971 Northeast 3,569,801 3,569,801 Texas 92,803,338 92,669,821 Other 7,959,941 7,559,941 360,603,613 358,802,534

Accounts Payable and Accrued _2

Accounts Payable and Accrued Liabilities (Tables)	12 Months Ended
	Dec. 31, 2020
Payables and Accruals [Abstract]
Summary of Accounts Payable and Accrued Liabilities	The accounts payable and accrued liabilities are as follows: 2020 $ 2019 $ Accounts payable 20,400,949 21,707,080 Accrued other expenses 10,034,409 2,602,292 Accrued payroll expenses 3,797,784 1,952,853 34,233,142 26,262,225

Earn-Out Liability (ADG Acqui_2

Earn-Out Liability (ADG Acquisition) (Tables)	12 Months Ended
	Dec. 31, 2020
Business Combinations [Abstract]
Summary of Earn-Out Liability	2020 $ 2019 $ ADG Acquisition – earn-out 4,688,553 14,834,067 Less: Current portion of ADG Acquisition – earn-out (4,688,553 ) (7,529,962) Non-current earn-out - 7,304,105

Lease Liabilities (Tables)

Lease Liabilities (Tables)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Summary of Finance Lease Liabilities		The information pertaining to finance lease liabilities on the consolidated balance sheet is as follows: 2020 $ 2019 $ Finance lease liabilities 15,573,586 8,415,404 Less: Current portion of finance lease liabilities (3,264,806 ) (1,789,995) Non-current 12,308,780 6,625,409
Summary of Finance Lease Cost		The components of finance lease cost recognized in the consolidated statement of operations and comprehensive income (loss) are as follows: 2020 $ 2019 $ Amortization expense for equipment under finance leases 2,927,249 1,794,673 Interest expense on finance lease liabilities 637,191 296,603 Finance lease cost 3,564,440 2,091,276
Summary of Undiscounted Cash Flows For Finance Leases	Undiscounted cash flows for finance leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 3,910,052 2022 3,768,295 2023 3,347,796 2024 2,749,931 2025 1,893,323 Thereafter 1,762,745 Total minimum lease payments 17,432,142 Less: Amount of lease payments representing interest (1,858,556) Present value of future minimum lease payments 15,573,586 Less: Current portion of finance lease liabilities (3,264,806) Non-current 12,308,780
Summary of Finance Lease Term and Discount Rates	The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-finance leases (years) 4.9 4.8 Weighted average discount rat e 4.6% 5.1%
Summary of Supplemental Cash Flow Information Related to Finance Leases	Supplemental cash flow information related to finance leases is as follows: 2020 $ 2019 $ Operating cash flows from finance leases 637,191 296,603 Financing cash flows from finance leases 1,524,548 904,193 Right-of-use 8,816,902 5,309,686
Summary of Operating Lease Liabilities	The information pertaining to operating lease liabilities on the consolidated balance sheet is as follows: 2020 $ 2019 $ Operating lease liabilities 132,299,312 129,049,990 Less: Current portion of operating lease liabilities (9,345,656 ) (9,276,298 ) Non-current 122,953,656 119,773,692
Summary of Operating Lease Cost	The components of operating lease cost recognized in the consolidated statement of operations and comprehensive income (loss) are as follows: 2020 $ 2019 $ Operating lease cost 20,624,622 18,040,356 Variable lease cost 4,109,277 3,478,748 Short-term lease cost 246,785 170,366 Total operating lease cost 24,980,684 21,689,470
Summary of Undiscounted Cash Flows For Operating Leases	Undiscounted cash flows for operating leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 18,380,966 2022 18,075,153 2023 17,224,588 2024 16,355,082 2025 15,659,482 Thereafter 137,590,224 Total minimum lease payments 223,285,495 Less: Amount of lease payments representing interest (90,986,183 ) Present value of future minimum lease payments 132,299,312 Less: Current portion of operating lease liabilities (9,345,656 ) Non-current 122,953,656
Summary of Operating Lease Term and Discount Rates	The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-operating leases (years) 12.7 14.1 Weighted average discount rate-operating leases 7.4% 7.1%
Summary of Supplemental Cash Flow Information Related to Operating Leases	Supplemental cash flow information related to operating leases is as follows: 2020 $ 2019 $ Operating cash flows from operating leases 17,672,048 15,660,780 Right-of-use 13,800,876 137,301,712

Senior loans payable (Tables)

Senior loans payable (Tables)	12 Months Ended
	Dec. 31, 2020
Summary of Maturities of Long-term Debt	$ 2021 405,698 2022 426,454 2023 296,356 2024 - 2025 400,000,000 401,128,508
2025 Senior Notes [Member]
Summary of debt	As at December 31, 2020, the 2025 Senior Notes had a face value of $400 million and an amortized cost balance of approximately, $389 million. 2020 $ 2019 $ 2025 Senior Notes 388,906,059 - Less: Current portion - - 388,906,059 -
2020 Revolving Facility [Member]
Summary of debt	As at December 31, 2020, the 2020 Revolving Facility had a face value and amortized cost balance of $nil (2019 - $nil). 2020 $ 2019 $ 2020 Revolving Facility - -
Amended May 2019 Loans [Member]
Summary of debt	The settlement of the Revolving Facility was considered debt modification for accounting purposes and a cost of approximately $0.9 million was added to the issuance costs of the 2020 Revolving Facility. 2020 $ 2019 $ Term Loan A and Revolving Facility - 87,824,000 Term Loan B - 250,710,995 Less: Current portion - (3,320,000 ) - 335,214,995
Wesley Chapel Loan [Member]
Summary of Maturities of Long-term Debt	Subject to the provisions described below, the minimum annual principal payments with respect to the Wesley Chapel Loan (face value) are as follows: $ 2021 405,698 2022 426,454 2023 296,356 1,128,508
Summary of debt	The fair value was determined based on management’s estimation of assumptions that market participants would use in pricing similar liabilities (it is considered a Level 3 liability as described in note 16). As at December 31, 2020, the Wesley Chapel Loan had an amortized cost balance of approximately, $1.1 million. 2020 $ 2019 $ Wesley Chapel Loan 1,079,684 1,447,327 Less: Current portion (405,698 ) (385,952 ) 673,986 1,061,375

Subordinated notes payable -&_2

Subordinated notes payable - earn-out (Tables)	12 Months Ended
	Dec. 31, 2020
Debt Disclosure [Abstract]
Summary of subordinated debt	2020 $ 2019 $ Subordinated note – earn-out - 184,485

Capital stock and warrants (Tab

Capital stock and warrants (Tables)	12 Months Ended
	Dec. 31, 2020
Equity [Abstract]
Summary of an unlimited number of voting common shares	The authorized share capital of the Company consists of an unlimited number of voting common shares, with no par value. Common shares Warrants RSUs Total Number Amount $ Number Amount $ Number Amount $ Number Amount $ January 1, 2019 62,371,275 123,746,423 1,249,512 1,742,910 1,120,656 2,671,147 64,741,443 128,160,480 Issuance (i) 6,250,000 23,437,500 - - - 1,559,418 6,250,000 24,996,918 RSUs and warrants exercised 1,219,653 4,813,632 (436,497) (569,733) (783,156) (2,932,753) - 1,311,146 Warrants expired - - (288,015) (438,798) - - (288,015) (438,798) December 31, 2019 69,840,928 151,997,555 525,000 734,379 337,500 1,297,812 70,703,428 154,029,746 Issuance (i) - - - - 14,138 - 14,138 RSUs settled 337,500 1,311,950 - - (337,500) (1,311,950) - - Warrants expired - - (525,000) (734,379) - - (525,000) (734,379) December 31, 2020 70,178,428 153,309,505 - - - - 70,178,428 153,309,505

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Summary of reconciliation of income tax expense (benefit)	The reconciliation of income tax expense (benefit) computed at the Canadian federal statutory rate to income tax expense (benefit) is as follows: 2020 $ 2019 $ Income attributable to common shareholders before income taxes (26,148,454 ) 13,163,526 Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%) (6,929,340 ) 3,488,334 Increase (decrease) in income taxes resulting from Stock-based compensation 396,528 942,013 State franchise tax, net of federal benefit 212,684 219,538 US tax rate differential 603,264 (400,948 ) Return to provision adjustment 345,299 1,389,866 Other (205,656 ) (164,747 ) Valuation allowance (173,849 ) (1,738,508 ) Income tax expense (benefit) (5,751,070 ) 3,735,548 U.S. Federal current tax expense (benefit) U.S. State current tax expense (benefit) (320,815 ) 1,643,043 Canadian current tax expense (benefit) U.S. Federal deferred tax expense (benefit) (4,433,785 ) 2,688,571 U.S. State deferred tax expense (benefit) (996,470 ) (596,066 ) Canadian deferred tax expense (benefit) Total income tax expense (benefit) (5,751,070 ) 3,735,548
Summary of the Company's deferred tax assets and liabilities	Deferred income taxes reflect the net tax effects of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amount used for income tax purposes. The Company’s deferred tax assets and liabilities are made up of the following components: 2020 $ 2019 $ Deferred tax assets Lease liabilities 31,615,510 33,474,270 Net operating losses 15,745,126 3,692,446 163(j) carryforward 5,934,846 1,458,105 Debt issuance costs 2,419,687 4,412,375 Capital acquisition costs 2,011,450 779,367 Other 3,409,797 9,430,097 Total deferred tax assets 61,136,416 53,246,660 Less: Valuation allowance (Canada) (2,634,364 ) (2,800,607 ) Net deferred tax assets 58,502,052 50,446,053 Deferred tax liabilities Right-of-use (30,360,097 ) (32,907,312 ) Fixed assets (14,973,077 ) (12,400,551 ) Goodwill (10,664,325 ) (8,392,326 ) Other (3,331,119 ) (3,002,684 ) Total deferred tax liabilities (59,328,618 ) (56,702,873 ) Net deferred tax liabilities (826,566 ) (6,256,820 )

Stock-Based Compensation R_2

Stock-Based Compensation – Options (Tables)	12 Months Ended
	Dec. 31, 2020
Share-based Payment Arrangement [Abstract]
Summary of stock options	Number of stock options Weighted average exercise price $ Aggregate grant date fair value $ Weighted average remaining contractual term (years) Outstanding – January 1, 2019 4,213,268 $2.18 $5,353,785 7.0 Cancelled (100,000) 3.74 (146,790) - Expired - - - - Exercised - - - - Granted 1,664,852 3.29 2,391,393 - Outstanding – December 31, 2019 5,778,120 2.47 7,598,388 6.3 Cancelled (18,000) 3.74 (26,422) - Expired - - - - Exercised - - - - Granted - - - - Outstanding – December 31, 2020 5,760,120 $2.47 $7,571,966 5.3 Exercisable at December 31, 2020 3,978,218 $2.03 $4,990,924 5.2
Summary of Fair Value Assumptions of Stock-based Option Awards	Date of options grant November 18, 2019 Underlying stock price 3.29 Exercise price 3.29 Term of options (years) 7.0 Volatility of underlying stock price 40% Expected dividend yield on underlying stock nil Annual risk free interest rate 1.48%

Risk Management Arising From _2

Risk Management Arising From Financial Instruments (Tables)	12 Months Ended
	Dec. 31, 2020
Fair Value Disclosures [Abstract]
Summary of estimated fair values of other non-current liabilities	The estimated fair values of other non-current 2020 $ 2019 $ 2025 Senior Notes 424,016,044 - Amended May 2019 loans payable - 360,596,500 Wesley Chapel Loan payable 1,122,400 1,483,830 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 951,105 429,826,997 378,049,987
Summary of Information Regarding the Change in Carrying Value of the Financial instruments at Fair Value	The following table summarizes information regarding the change in carrying value of the Company’s financial instruments carried at fair value. Derivative Subordinated Earn-out $ ADG Earn-out $ January 1, 2019 (16,014) 169,642 - Issuance - - 14,748,022 Financial instruments revaluation loss (gain) Realized - - - Unrealized 967,119 14,843 86,045 December 31, 2019 951,105 184,485 14,834,067 Payment (4,805,000) (200,000) (4,688,553) Financial instruments revaluation loss (gain) Realized 3,853,895 15,515 (2,728,480) Unrealized - - (2,728,481) December 31, 2020 - - 4,688,553
Summary of Information Regarding The Carrying Value Of Financial Instruments	The following table summarizes information regarding the carrying value of the Company’s financial instruments: 2020 $ 2019 $ Cash 44,395,988 23,388,916 Accounts receivable 91,126,923 82,867,225 Financial assets measured at amortized cost 135,522,911 106,256,141 Accounts payable and accrued liabilities 34,233,142 26,262,225 Short-term portion of senior loans payable 405,698 3,705,952 Short-term portion of leases 12,610,462 11,066,293 Long-term portion of senior loans payable 389,580,046 336,276,370 Long-term portion of leases 135,262,436 126,399,101 Financial liabilities measured at amortized cost 572,091,784 503,709,941 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 951,105 Measured at fair value through profit or loss 4,688,553 15,969,657
Schedule of Exposure to Interest Rate Risk And Effect On Other Comprehensive Income Loss	2020 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (n/a as settled in November 2020) - - - 2019 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (originated in May 2019) 338,534,995 1,180,247 (1,979,043 ) Syndicated Loans (n/a as settled in May 2019) - - - 338,534,995 1,180,247 (1,979,043 )

Basic And Diluted Income (Los_2

Basic And Diluted Income (Loss) Per Share (Tables)	12 Months Ended
	Dec. 31, 2020
Earnings Per Share [Abstract]
Summary Of Earnings Per Share Basic And Diluted	2020 $ 2019 $ Net income (loss) attributable to common shareholders (20,397,384 ) 9,427,978 Weighted average common shares outstanding Basic 70,101,618 66,528,051 Add: additional shares issuable upon exercise of employee stock options, warrants and restricted share units 2,066,938 Diluted 70,101,618 68,594,989 Net income (loss) per share Basic and diluted (0.29 ) 0.14 Employee stock options warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,664,231

Financial Instruments Revalua_2

Financial Instruments Revaluation And Other Gains (Losses) (Tables)	12 Months Ended
	Dec. 31, 2020
Financial Instruments Revaluation And Other Gains Losses [Abstract]
Operational Financial instruments revaluation and other gains (losses)	a) Operational Financial instruments revaluation and other gains (losses) 2020 $ 2019 $ Gain (loss) on revaluation of ADG Acquisition – Earn-out 5,456,961 (86,045 ) Loss on disposal of property and equipment (1,549,295 ) (931,356 ) (3,907,666 ) (1,017,401 )
Other Financial instruments revaluation and other gains (losses)	b) Other Financial instruments revaluation and other gains (losses) 2020 $ 2019 $ Loss on debt revaluation (note 10) (18,278,845 ) (829,208 ) Loss on revaluation of derivatives (note 10) (3,853,895 ) (967,119 ) Other gains (losses) 53,995 (9,489 ) (22,078,745 ) (1,805,816 )

Revenue Information (Tables)

Revenue Information (Tables)	12 Months Ended
	Dec. 31, 2020
Revenue from Contract with Customer [Abstract]
Summary of Revenue Information	2020 $ 2019 $ Commercial 163,893,988 173,056,345 Medicare 28,449,283 28,849,651 Medicaid 7,889,878 7,421,432 Attorney 24,271,130 14,784,804 Workers comp 9,960,660 10,569,156 Other patient revenue 9,516,244 10,160,012 Service fees - net of allowances and discounts 243,981,183 244,841,400 Other revenue (management and ancillary fees and government grants) 7,301,666 2,594,903 251,282,849 247,436,303

Cost Of Operations, Excluding_2

Cost Of Operations, Excluding Depreciation And Amortization (Tables)	12 Months Ended
	Dec. 31, 2020
Cost Of Operations Excluding Depreciation And Amortization [Abstract]
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization	2020 $ 2019 $ Employee compensation 84,038,371 85,899,654 Reading fees 37,817,457 35,243,843 Rent and utilities 30,203,346 26,332,049 Third party services and professional fees 21,706,906 19,084,397 Administrative 12,875,606 12,459,281 Medical supplies and other 11,161,702 8,783,377 197,803,388 187,802,601

Non-Controlling Interests (Tabl

Non-Controlling Interests (Tables)	12 Months Ended
	Dec. 31, 2020
Noncontrolling Interest Items [Abstract]
Summary of Effective Ownership Interest Held in the Non-Wholly Owned Entities	The Company currently holds effective ownership interests in the following non-wholly Ownership interest Entity 2020 2019 % % Phoenix Imaging, LLC 60 60 Preferred Imaging of Amarillo, LLC 57 57

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Summary of Property and Equipment and Estimated Useful Lives Using the Straight Line Method (Detail)	12 Months Ended
	Dec. 31, 2020
Medical equipment and equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	6 years
Furniture and fittings [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	9 years
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	over term of lease
Minimum [Member] | Computer and office equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	4 years
Maximum [Member] | Computer and office equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	5 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Summary of Definite Lived Intangible Assets Useful Life (Detail)	12 Months Ended
	Dec. 31, 2020
Covenant not to compete [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, useful life	over term of contract
Minimum [Member] | Software costs trade name and license arrangements [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, useful life	5 years
Maximum [Member] | Software costs trade name and license arrangements [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, useful life	6 years

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($)	3 Months Ended	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Significant Accounting Policies [Line Items]
Assets	$ 718,684,541	$ 718,684,541	$ 683,000,517
Liabilities	578,952,991	578,952,991	525,937,015
Revenues		7,301,666	2,594,903
Net cash provided by (used in) operating activities		26,690,553	12,581,077
Operating lease, right-of-use asset	127,061,894	127,061,894	126,675,770	$ 98,912,687
Operating lease, liability	$ 132,299,312	132,299,312	129,049,990	$ 98,912,687
Increase (decrease) in accounts receivable		$ 8,259,697	$ 25,243,156
Earnings per share, basic and diluted		$ (0.29)	$ 0.14
Accounts Receivable [Member]
Significant Accounting Policies [Line Items]
Increase (decrease) in accounts receivable		$ 12,300,000	$ 9,400,000
Earnings per share, basic and diluted	$ 0.13	$ 0.13
Minimum [Member]
Significant Accounting Policies [Line Items]
Lessee, operating lease, term of contract	3 years	3 years
Lessee, operating lease, renewal term	10 years	10 years
Maximum [Member]
Significant Accounting Policies [Line Items]
Lessee, operating lease, term of contract	10 years	10 years
Lessee, operating lease, renewal term	30 years	30 years
Variable Interest Entity, Primary Beneficiary [member]
Significant Accounting Policies [Line Items]
Assets	$ 57,000,000	$ 57,000,000	58,700,000
Liabilities	$ 2,400,000	2,400,000	0
Revenues		139,100,000	151,900,000
Net cash provided by (used in) operating activities		$ 134,700,000	$ 112,000,000

Business Combination - Summary

Business Combination - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Non-current liabilities
Goodwill	$ 360,603,613	$ 358,802,534	$ 147,120,852
Coral Springs [Member]
Current assets
Prepaid expenses	32,961
Non-current assets
Security deposits	368,601
Property and equipment	412,400
Operating lease right-of-use assets	2,427,618
Assets	3,241,580
Non-current liabilities
Operating lease liabilities (right-of-use)	2,427,618
Net assets acquired	813,962
Goodwill	1,274,764
Purchase price	2,088,726
Crystal Lake [Member]
Non-current assets
Security deposits	5,799
Property and equipment	820,000
Operating lease right-of-use assets	554,830
Assets	1,380,629
Non-current liabilities
Operating lease liabilities (right-of-use)	554,830
Net assets acquired	825,799
Goodwill	400,000
Purchase price	1,225,799
Davie Acquisition [Member]
Non-current assets
Property and equipment	170,000
Operating lease right-of-use assets	427,558
Assets	597,558
Non-current liabilities
Operating lease liabilities (right-of-use)	427,558
Net assets acquired	170,000
Goodwill	280,000
Purchase price	450,000
ADG Acquisitions [Member]
Current assets
Cash	3,585,672
Accounts receivable	19,418,814
Prepaid expenses	269,012
Current assets	23,273,498
Non-current assets
Property and equipment	11,508,940
Operating lease right-of-use assets	16,912,896
Intangible assets	5,870,000
Non-current assets	34,291,836
Assets	57,565,334
Current liabilities
Accounts payable and accrued liabilities	5,634,661
Non-current liabilities
Deferred tax liability	422,056
Operating lease liabilities (right-of-use)	16,912,896
Non-current liabilities	17,334,952
Liabilities	22,969,613
Net assets acquired	34,595,721
Goodwill	195,937,055
Purchase price (cash and shares)	215,784,755
Purchase price (ADG Acquisition – earn-out (note 8))	14,748,021
Deltona Acquisition [Member]
Non-current assets
Property and equipment	295,000
Operating lease right-of-use assets	154,136
Non-current assets	449,136
Current liabilities
Accounts payable and accrued liabilities	57,880
Non-current liabilities
Operating lease liabilities (right-of-use)	154,136
Liabilities	212,016
Net assets acquired	237,120
Goodwill	411,267
Purchase price	648,387
El Paso Acquisition [Member]
Current assets
Accounts receivable	1,275,726	1,275,726
Prepaid expenses	19,789	19,789
Current assets	1,295,515	1,295,515
Non-current assets
Property and equipment	3,922,481	3,922,481
Operating lease right-of-use assets	3,683,989	3,683,989
Intangible assets	720,000	720,000
Assets	9,621,985	9,621,985
Current liabilities
Accounts payable and accrued liabilities	1,174,040	1,024,631
Non-current liabilities
Operating lease liabilities (right-of-use)	3,683,989	3,683,989
Liabilities	4,858,029	4,708,620
Net assets acquired	4,763,956	4,913,365
Goodwill	6,220,153	6,086,635
Purchase price	10,984,109	11,000,000
West Palm Beach Acquisition [Member]
Current assets
Accounts receivable	2,085,491	2,085,491
Prepaid expenses	90,454	90,454
Current assets	2,175,945	2,175,945
Non-current assets
Security deposits	9,000	9,000
Property and equipment	2,432,234	2,432,234
Operating lease right-of-use assets	13,625,521	13,625,521
Intangible assets	1,080,000	1,080,000
Assets	19,322,700	19,322,700
Current liabilities
Accounts payable and accrued liabilities	1,404,268	1,311,471
Non-current liabilities
Finance leases	587,434	587,434
Operating lease liabilities (right-of-use)	13,625,521	13,625,521
Liabilities	15,617,223	15,524,426
Net assets acquired	3,705,477	3,798,274
Goodwill	14,064,109	14,071,312
Purchase price	$ 17,769,586	$ 17,869,586

Business Combination - Summar_2

Business Combination - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Parenthetical) (Detail) $ / shares in Units, shares in Thousands	Jan. 01, 2020USD ($)	Oct. 04, 2019USD ($)	Oct. 01, 2019USD ($)	Aug. 16, 2019USD ($)	May 31, 2019USD ($)$ / sharesshares	Apr. 15, 2019USD ($)Agreement	Apr. 01, 2019USD ($)	Jun. 30, 2020USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Business Acquisition [Line Items]
Business acquisition, pro forma revenue										$ 400,000
Income (loss) from subsidiaries, before tax										41,000
Revenues									$ 7,301,666	2,594,903
Number of centres | Agreement						27
FLORIDA
Business Acquisition [Line Items]
Number of centres | Agreement						21
GEORGIA
Business Acquisition [Line Items]
Number of centres | Agreement						6
Coral Springs [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred	$ 2,100,000							$ 100,000
Business acquisition, pro forma revenue									4,100,000	5,400,000
Income (loss) from subsidiaries, before tax									700,000	900,000
Crystal Lake [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred	$ 1,200,000							$ 60,000
Business acquisition, pro forma revenue									1,000,000	1,100,000
Income (loss) from subsidiaries, before tax									$ 200,000	200,000
Davie Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred			$ 50,000				$ 450,000
Business acquisition, pro forma revenue										247,600,000
Income (loss) from subsidiaries, before tax										54,000
Revenues										500,000
Business acquisition, pro forma income before tax										13,200,000
ADG Acquisitions [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred						$ 216,000,000
Business acquisition, pro forma revenue										277,500,000
Income (loss) from subsidiaries, before tax										29,700,000
Revenues										72,600,000
Business acquisition, pro forma income before tax										25,500,000
Business combination, consideration transferred, equity interests issued and issuable					$ 23,400,000
Business acquisition, share price | $ / shares					$ 3.75
Business acquisition, equity interest issued or issuable, number of shares | shares					6,250
Business combination consideration transferred decrease in amount					$ 200,000
Deltona Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred					$ 648,387
Business acquisition, pro forma revenue										248,800,000
Income (loss) from subsidiaries, before tax										1,000,000
Revenues										3,200,000
Business acquisition, pro forma income before tax										13,600,000
Deltona Acquisition [Member] | FLORIDA
Business Acquisition [Line Items]
Income (loss) from subsidiaries, before tax										600,000
Revenues										1,900,000
El Paso Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred				$ 11,000,000
Business acquisition, pro forma revenue										256,100,000
Income (loss) from subsidiaries, before tax										3,000,000
Revenues										14,000,000
Business acquisition, pro forma income before tax										15,000,000
Business combination consideration transferred decrease in amount				$ 16,000
El Paso Acquisition [Member] | TEXAS
Business Acquisition [Line Items]
Income (loss) from subsidiaries, before tax										1,100,000
Revenues										5,300,000
West Palm Beach Acquisition [Member]
Business Acquisition [Line Items]
Business combination, consideration transferred		$ 18,000,000
Business acquisition, pro forma revenue										262,400,000
Income (loss) from subsidiaries, before tax										1,600,000
Revenues										19,800,000
Business acquisition, pro forma income before tax										14,400,000
Business combination consideration transferred decrease in amount		$ 100,000
West Palm Beach Acquisition [Member] | FLORIDA
Business Acquisition [Line Items]
Income (loss) from subsidiaries, before tax										400,000
Revenues										4,800,000
ADG Acquisitions, Since Acquisition [Member]
Business Acquisition [Line Items]
Income (loss) from subsidiaries, before tax										17,400,000
Revenues										$ 42,500,000

Property and Equipment - Summar

Property and Equipment - Summary of Detailed Information of Property and Equipment (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 130,048,023	$ 109,529,144
Less: accumulated depreciation	(50,118,449)	(33,590,554)
Total property and equipment – net	79,929,574	75,938,590
Medical equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	85,588,228	75,665,771
Equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	23,168,355	14,971,916
Total property and equipment – net	14,981,186	9,404,765
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	19,360,169	17,393,839
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	1,479,320	1,088,236
Office equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	211,032	214,612
Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment – cost	$ 240,919	$ 194,770

Property and Equipment - Additi

Property and Equipment - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 79,929,574	$ 75,938,590
Depreciation	17,769,948	13,705,653
Property, plant and equipment, disposals	1,779,626	1,030,006
Financial instruments revaluation and other gains losses [Member]
Property, Plant and Equipment [Line Items]
Gain (loss) on disposition of property plant equipment	(1,549,295)	(931,356)
Equipment under finance leases [Member]
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 14,981,186	$ 9,404,765

Intangible Assets - Summary of

Intangible Assets - Summary of Intangible Assets (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Acquired Finite-Lived Intangible Assets [Line Items]
Beginning balance, Cost	$ 12,325,447	$ 4,652,772
Beginning balance, Accumulated amortization	2,892,967	1,011,420
Additions	5,412	2,675
Business acquisitions (note 3)		7,670,000
Amortization	2,689,819	1,881,547
Ending balance, Cost	12,330,859	12,325,447
Ending balance, Accumulated amortization	5,582,786	2,892,967
Net book value	$ 6,748,073	9,432,480
Weighted average remaining amortization period (years)	2 years 6 months
Covenants not to compete [member]
Acquired Finite-Lived Intangible Assets [Line Items]
Beginning balance, Cost	$ 3,137,917	1,127,917
Beginning balance, Accumulated amortization	917,918	323,611
Business acquisitions (note 3)		2,010,000
Amortization	868,572	594,307
Ending balance, Cost	3,137,917	3,137,917
Ending balance, Accumulated amortization	1,786,490	917,918
Net book value	$ 1,351,427	2,219,999
Weighted average remaining amortization period (years)	1 year 6 months
Software Cost [member]
Acquired Finite-Lived Intangible Assets [Line Items]
Beginning balance, Cost	$ 244,530	241,855
Beginning balance, Accumulated amortization	151,198	119,225
Additions	5,412	2,675
Amortization	32,648	31,973
Ending balance, Cost	249,942	244,530
Ending balance, Accumulated amortization	183,846	151,198
Net book value	$ 66,096	93,332
Weighted average remaining amortization period (years)	2 years
Trade Names [member]
Acquired Finite-Lived Intangible Assets [Line Items]
Beginning balance, Cost	$ 7,823,000	3,283,000
Beginning balance, Accumulated amortization	1,693,185	568,584
Business acquisitions (note 3)		4,540,000
Amortization	1,564,599	1,124,601
Ending balance, Cost	7,823,000	7,823,000
Ending balance, Accumulated amortization	3,257,784	1,693,185
Net book value	$ 4,565,216	6,129,815
Weighted average remaining amortization period (years)	2 years 9 months 18 days
Licensing Agreements [member]
Acquired Finite-Lived Intangible Assets [Line Items]
Beginning balance, Cost	$ 1,120,000
Beginning balance, Accumulated amortization	130,666
Business acquisitions (note 3)		1,120,000
Amortization	224,000	130,666
Ending balance, Cost	1,120,000	1,120,000
Ending balance, Accumulated amortization	354,666	130,666
Net book value	$ 765,334	$ 989,334
Weighted average remaining amortization period (years)	3 years 6 months

Intangible Assets - Summary o_2

Intangible Assets - Summary of Finite-Lived Intangible Assets Net Amortization Expense (Detail)	Dec. 31, 2020USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2021	$ 2,710,490
2022	2,190,685
2023	1,275,099
2024	570,223
2025	1,125
Total	$ 6,747,622

Goodwill - Summary of Goodwill

Goodwill - Summary of Goodwill (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Balance – Beginning of period	$ 358,802,534	$ 147,120,852
Adjustments (note 3)	126,315	(5,104,587)
Business acquisitions (note 3)	1,674,764	216,786,269
Balance – End of period	$ 360,603,613	$ 358,802,534

Goodwill - Summary of Carrying

Goodwill - Summary of Carrying Amount of Goodwill (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Summary of carrying amount of goodwill as follows:
Goodwill	$ 360,603,613	$ 358,802,534	$ 147,120,852
Florida [member]
Summary of carrying amount of goodwill as follows:
Goodwill	256,270,533	255,002,971
Northeast [member]
Summary of carrying amount of goodwill as follows:
Goodwill	3,569,801	3,569,801
Texas [member]
Summary of carrying amount of goodwill as follows:
Goodwill	92,803,338	92,669,821
Other [member]
Summary of carrying amount of goodwill as follows:
Goodwill	$ 7,959,941	$ 7,559,941

Accounts Payable and Accrued _3

Accounts Payable and Accrued Liabilities - Summary of Accounts Payable and Accrued Liabilities (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Payables and Accruals [Abstract]
Accounts payable	$ 20,400,949	$ 21,707,080
Accrued other expenses	10,034,409	2,602,292
Accrued payroll expenses	3,797,784	1,952,853
Accounts payable and accrued liabilities	$ 34,233,142	$ 26,262,225

Earn-Out Liability (ADG Acqui_3

Earn-Out Liability (ADG Acquisition) - Summary of Earn-Out Liability (Detail) - Earn-out liability [Member] - ADG [Member] - USD ($)	Dec. 31, 2020	Nov. 30, 2020	Dec. 31, 2019
Business Acquisition, Contingent Consideration [Line Items]
ADG Acquisition – earn-out	$ 4,688,553	$ 9,400,000	$ 14,834,067
Less: Current portion of ADG Acquisition – earn-out	(4,688,553)		(7,529,962)
Non-current portion of ADG Acquisition – earn-out	$ 0		$ 7,304,105

Earn-Out Liability (ADG Acqui_4

Earn-Out Liability (ADG Acquisition) - Additional Information (Detail) - ADG [Member] - Earn-out liability [Member]	Dec. 31, 2019USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Nov. 30, 2020USD ($)	May 31, 2019USD ($)
Business Acquisition, Contingent Consideration [Line Items]
Percentage of contingent consideration liability settled		50.00%
Business combination contingent consideration liability	$ 14,834,067	$ 4,688,553	$ 4,688,553	$ 14,834,067	$ 9,400,000
Percentage of increase decrease in discount rate	1.00%
Percentage of increase decrease in contingent consideration	$ 200,000
Change in amount of contingent consideration liability			$ 5,500,000	$ (100,000)
Level 3 [Member]
Business Acquisition, Contingent Consideration [Line Items]
Business combination contingent consideration liability						$ 14,700,000
Level 3 [Member] | Measurement Input, Discount Rate [Member]
Business Acquisition, Contingent Consideration [Line Items]
Contingent consideration liability measurement input (%)						7

Lease Liabilities - Summary of

Lease Liabilities - Summary of Finance Lease Liabilities (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Finance lease liabilities	$ 15,573,586	$ 8,415,404
Less: Current portion of finance lease liabilities	(3,264,806)	(1,789,995)
Non-current portion of finance lease liabilities	$ 12,308,780	$ 6,625,409

Lease Liabilities - Summary o_2

Lease Liabilities - Summary of Finance Lease Cost (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Amortization expense for equipment under finance leases	$ 2,927,249	$ 1,794,673
Interest expense on finance lease liabilities	637,191	296,603
Finance lease cost	$ 3,564,440	$ 2,091,276

Lease Liabilities - Summary o_3

Lease Liabilities - Summary of Undiscounted Cash Flows For Finance Leases (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Finance Lease, Liability, Payment, Due [Abstract]
2021	$ 3,910,052
2022	3,768,295
2023	3,347,796
2024	2,749,931
2025	1,893,323
Thereafter	1,762,745
Total minimum lease payments	17,432,142
Less: Amount of lease payments representing interest	(1,858,556)
Present value of future minimum lease payments	15,573,586	$ 8,415,404
Less: Current portion of finance lease liabilities	(3,264,806)	(1,789,995)
Non-current portion of finance lease liabilities	$ 12,308,780	$ 6,625,409

Lease Liabilities - Summary o_4

Lease Liabilities - Summary of Finance Lease Term and Discount Rates (Detail)	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Weighted average remaining lease term-finance leases (years)	4 years 10 months 24 days	4 years 9 months 18 days
Weighted average discount rate-finance leases	4.60%	5.10%

Lease Liabilities - Summary o_5

Lease Liabilities - Summary of Supplemental Cash Flow Information Related to Finance Leases (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating cash flows from finance leases	$ 637,191	$ 296,603
Financing cash flows from finance leases	1,524,548	904,193
Right-of-use assets obtained in exchange for finance lease obligations	$ 8,816,902	$ 5,309,686

Lease Liabilities - Summary o_6

Lease Liabilities - Summary of Operating Lease Liabilities (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Leases [Abstract]
Operating lease liabilities	$ 132,299,312	$ 129,049,990	$ 98,912,687
Less: Current portion of operating lease liabilities	(9,345,656)	(9,276,298)
Non-current portion of operating lease liabilities	$ 122,953,656	$ 119,773,692

Lease Liabilities - Summary o_7

Lease Liabilities - Summary of Operating Lease Cost (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease cost	$ 20,624,622	$ 18,040,356
Variable lease cost	4,109,277	3,478,748
Short-term lease cost	246,785	170,366
Total operating lease cost	$ 24,980,684	$ 21,689,470

Lease Liabilities - Summary o_8

Lease Liabilities - Summary of Undiscounted Cash Flows For Operating Leases (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
2021	$ 18,380,966
2022	18,075,153
2023	17,224,588
2024	16,355,082
2025	15,659,482
Thereafter	137,590,224
Total minimum lease payments	223,285,495
Less: Amount of lease payments representing interest	(90,986,183)
Present value of future minimum lease payments	132,299,312	$ 129,049,990	$ 98,912,687
Less: Current portion of operating lease liabilities	(9,345,656)	(9,276,298)
Non-current portion of operating lease liabilities	$ 122,953,656	$ 119,773,692

Lease Liabilities - Summary o_9

Lease Liabilities - Summary of Operating Lease Term and Discount Rates (Detail)	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Weighted average remaining lease term-operating leases (years)	12 years 8 months 12 days	14 years 1 month 6 days
Weighted average discount rate-operating leases	7.40%	7.10%

Lease Liabilities - Summary _10

Lease Liabilities - Summary of Supplemental Cash Flow Information Related To Operating Leases (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating cash flows from operating leases	$ 17,672,048	$ 15,660,780
Right-of-use assets obtained in exchange for operating lease obligations	$ 13,800,876	$ 137,301,712

Senior loans payable - Summary

Senior loans payable - Summary of Maturities of Long-term Debt (Detail)	Dec. 31, 2020USD ($)
Short-term Debt [Line Items]
2021	$ 405,698
2022	426,454
2023	296,356
2024	0
2025	400,000,000
Long-term Debt	401,128,508
Wesley Chapel Loan [Member]
Short-term Debt [Line Items]
2021	405,698
2022	426,454
2023	296,356
Long-term Debt	$ 1,100,000

Senior loans payable - Summar_2

Senior loans payable - Summary of debt (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Long-term Debt	$ 401,128,508
2025 Senior Notes [Member]
Debt Instrument [Line Items]
Long-term Debt	389,000,000	$ 0
Long-term Debt, Current	0	0
Long-term Debt, Non-current	388,906,059	0
2020 Revolving Facility [Member]
Debt Instrument [Line Items]
Long-term Debt	0	0
Amended May 2019 Loans [Member]
Debt Instrument [Line Items]
Long-term Debt, Current	0	(3,320,000)
Long-term Debt, Non-current	0	335,214,995
Amended May 2019 Loans [Member] | Term Loan A And Revolving Facility [Member]
Debt Instrument [Line Items]
Long-term Debt	0	87,824,000
Amended May 2019 Loans [Member] | Term Loan B [Member]
Debt Instrument [Line Items]
Long-term Debt	0	250,710,995
Wesley Chapel Loan [Member]
Debt Instrument [Line Items]
Long-term Debt	1,100,000
Long-term Debt, Current	(405,698)	(385,952)
Long-term Debt, Non-current	673,986	1,061,375
Wesley Chapel Loan [Member] | Term Loan A And Revolving Facility [Member]
Debt Instrument [Line Items]
Long-term Debt	$ 1,079,684	$ 1,447,327

Senior loans payable - Addition

Senior loans payable - Additional Information (Detail) - USD ($)	Dec. 31, 2020	Nov. 02, 2020	Jul. 31, 2019	May 31, 2019	Nov. 14, 2018	Aug. 15, 2018	Oct. 31, 2019	May 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Jun. 02, 2020
Debt Instrument [Line Items]
Long-term Debt	$ 401,128,508								$ 401,128,508
Line of Credit facility interest rate description									(i) each Eurodollar Rate Loan bears interest on the outstanding principal amount at Adjusted Eurodollar Rate (effectively, LIBOR) plus the Applicable Rate; (ii) each Base Rate Loan bears interest on the outstanding principal amount at the Base Rate (the highest of (a) the Prime Rate, (b) the Federal Reserve Bank of New York Rate plus 0.5% and (c) one-month Adjusted Eurodollar Rate plus 1.0%) plus the Applicable Rate; and (iii) each Swingline Loan bears interest on the outstanding principal amount at the Base Rate plus the Applicable Rate.
Debt instrument fair value	429,826,997								$ 429,826,997	$ 378,049,987
Syndicated Term Loan [Member]
Debt Instrument [Line Items]
Proceeds From Derivative Financial Instrument		$ 0								597
Derivative, Gain (Loss) on Derivative									$ 597
Amended May 2019 Loans [Member]
Debt Instrument [Line Items]
Debt Face Amount					$ 50,000,000
Long-term Debt										338,500,000
Proceeds from issuance of debt							$ 16,000,000
Debt instrument term									5 years
Debt instrument maturity date range start									May 31, 2019
Increase in debt instrument for period									$ 100,000,000
Debt instrument fair value				$ 319,300,000				$ 319,300,000
Debt Issuance cost net				14,800,000				14,800,000
Take as Extension		364,000,000
Derivative cap interest rate					3.75%
Percentage of debt instrument notional amount					50.00%
Derivative Maturity Dates					Aug. 31, 2021
Derivative financial instrument costs					$ 155,000
Loss on extinguishment of debt				$ (18,000,000)
Amended May 2019 Loans [Member] | Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Line of credit facility maximum borrowing capacity	50,000,000								50,000,000		$ 69,000,000
7.0% senior secured notes [Member]
Debt Instrument [Line Items]
Debt Face Amount		$ 400,000,000
Debt Interest Rate		7.00%
Debt Maturity Date		Nov. 1, 2025
2025 Senior Notes [Member]
Debt Instrument [Line Items]
Debt Face Amount	400,000,000	$ 400,000,000							$ 400,000,000
Debt Maturity Date		Nov. 1, 2025
Cash		$ 19,000,000
Payments For Debt Issuance Costs		$ 11,500,000
Frequency of Periodic Payment									six months
Long-term Debt	389,000,000								$ 389,000,000	0
Line of credit facility maximum borrowing capacity	50,000,000								50,000,000
Minimum debt instrument holders percentage to declare amount immediately due in debt default		25.00%
2020 Revolving Facility [Member]
Debt Instrument [Line Items]
Debt Face Amount	0								0	0
Long-term Debt	0								0	0
Payments of Debt Restructuring Costs									900,000
Line of credit facility maximum borrowing capacity	55,000,000								$ 55,000,000
Line of credit maturity period									5 years
Line of credit maturity date description									if more than $50 million in aggregate principal amount of the 2025 Senior Notes is outstanding on the date that is 181 days prior to the 2020 Revolving Facility Maturity Date, then the 2020 Revolving Facility Maturity Date shall instead be the date that is 181 days prior to the 2020 Revolving Facility Maturity Date.
Line of credit facility issuance costs	$ 2,000,000								$ 2,000,000
Annual Commitment Fee Capped Percentage	0.50%
Line of credit facility undrawn amount	$ 0								$ 0	0
Debt instrument covenant description									leverage ratio that is tested on the last day of any fiscal quarter (commencing with the fiscal quarter ending March 31, 2021) only if on the last day of any such fiscal quarter, the outstanding amount under the 2020 Revolving Facility (excluding certain letter of credit obligations) exceeds 30% of the total commitment under the 2020 Revolving Facility of $55 million.
Line of credit debt service coverage ratio	30.00%								30.00%
Total Commitment amount									$ 55,000,000
2020 Revolving Facility [Member] | 1% Increase In Variable Interest rate [Member]
Debt Instrument [Line Items]
Increase in interest expense									0	0
2020 Revolving Facility [Member] | Federal Reserve Bank Of New York rate [Member]
Debt Instrument [Line Items]
Debt instrument description of variable rate basis	the Federal Reserve Bank of New York Rate plus 0.5%
Line of Credit Facility Interest rate	0.50%
2020 Revolving Facility [Member] | Adjusted Eurodollar Rate Plus Applicable Rate [Member]
Debt Instrument [Line Items]
Debt instrument description of variable rate basis	one-month Adjusted Eurodollar Rate plus 1.0%) plus the Applicable Rate
Line of Credit Facility Interest rate	1.00%
Wesley Chapel Loan [Member]
Debt Instrument [Line Items]
Debt Face Amount	$ 37,742					$ 2,000,000			$ 37,742
Debt Interest Rate	5.00%					5.00%			5.00%
Debt Maturity Date						Aug. 15, 2023
Long-term Debt	$ 1,100,000								$ 1,100,000
Debt instrument periodic payment						$ 37,742
Long-term debt fair value						$ 1,908,456
Prior Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Line of credit facility issuance costs	900,000								900,000
Term Loan A [Member] | Amended May 2019 Loans [Member]
Debt Instrument [Line Items]
Debt Face Amount	66,000,000								66,000,000
Term Loan B [Member]
Debt Instrument [Line Items]
Proceeds From Derivative Financial Instrument		$ 4,805,000								951,702
Derivative, Gain (Loss) on Derivative									3,900,000
Percentage Of Financial Instrument Underlying Notional Amount			100.00%
Derivative, Notional Amount			$ 266,000,000
Upfront cost									0
Interest expense borrowings									1,301,854	0
Term Loan B [Member] | Amended May 2019 Loans [Member]
Debt Instrument [Line Items]
Debt Face Amount	$ 266,000,000								$ 266,000,000
Term Loan B [Member] | London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument [Line Items]
Derivative, Cap Interest Rate			3.00%
Derivative, Floor Interest Rate			1.1475%
Syndicate Loans [Member] | Amended May 2019 Loans [Member]
Debt Instrument [Line Items]
Proceeds from issuance of debt used to settle other debt										112,482,181
Debt instrument increase decrease from modification								$ 1
Subordinated Note [Member] | Amended May 2019 Loans [Member]
Debt Instrument [Line Items]
Proceeds from issuance of debt used to settle other debt										$ 1,596,250

Subordinated notes payable -&_3

Subordinated notes payable - earn-out - Summary of Subordinated Debt (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Subordinated Notes Earnout [Member]
Debt Instrument [Line Items]
Subordinated debt	$ 0	$ 184,485

Subordinated notes payable -&_4

Subordinated notes payable - earn-out - Additional Information (Detail) - USD ($)	Oct. 23, 2020	May 31, 2019	May 11, 2018	Dec. 31, 2020	Dec. 31, 2019
Subordinated Notes Earnout [Member]
Debt Instrument [Line Items]
Subordinated notes interest rate			6.00%
Subordinate notes face value			$ 1,500,000
Subordinated notes term			4 years
Settlement of earn out	$ 200,000
Loss on extinguishment of debt				$ (15,515)
Discount rate used for estimating fair value of subordinated notes			8.75%
Subordinated note settlement liability outstanding				0	$ 184,485
Gain loss on extinguishment of debt				$ (15,515)
Subordinated Notes Earnout [Member] | Revenue Based Milestone [Member]
Debt Instrument [Line Items]
Business combination contingent consideration maximum outcome					$ 4,000,000
Period of earnout payment					3 years
Subordinated note earn out percentage				50.00%	50.00%
Base revenue to be earned for payment of earnout liability				$ 16,000,000	$ 16,000,000
Subordinated Notes Earnout [Member] | Revenue Based Milestone [Member] | Minimum [Member]
Debt Instrument [Line Items]
Base revenue to be earned for payment of earnout liability				$ 16,000,000	16,000,000
Subordinated Notes Earnout [Member] | Level 3 [Member] | Measurement Input, Discount Rate [Member]
Debt Instrument [Line Items]
Subordinated notes fair value			$ 160,790
Subordinated Notes Earnout [Member] | Level 3 [Member] | Based On Effective Rate [Member]
Debt Instrument [Line Items]
Subordinated notes fair value			$ 1,490,932
Subordinated Notes due on May 31, 2019 [Member]
Debt Instrument [Line Items]
Subordinate notes face value		$ 1,500,000
Early repayment of subordinated debt		$ 1,596,250
Interest expenses on subordinated debt					96,250
Loss on extinguishment of debt					(6,830)
Gain loss on extinguishment of debt					$ (6,830)

Capital stock and warrants - Su

Capital stock and warrants - Summary of an Unlimited Number of Voting Common Shares (Detail) - USD ($)	1 Months Ended	12 Months Ended
	Apr. 30, 2020	Dec. 31, 2020	Dec. 31, 2019
Class of Stock [Line Items]
Beginning balance, shares		69,840,928
Ending balance, shares		70,178,428	69,840,928
Beginning balance warrants , shares	52,500	525,000	1,249,512
Beginning balance warrants		$ 734,379	$ 1,742,910
RSUs and warrants exercised, warrants , shares			(436,497)
RSUs and warrants exercised			$ (569,733)
Warrants expired, shares		(525,000)	(288,015)
Warrants expired		$ (734,379)	$ (438,798)
Ending balance warrants, shares			525,000
Ending balance warrants			$ 734,379
Beginning balance RSUs, shares		337,500	1,120,656
Beginning balance RSUs		$ 1,297,812	$ 2,671,147
Issuance RSUs		$ 14,138	$ 1,559,418
RSUs and warrants exercised, RSUs shares		(337,500)	(783,156)
RSUs and warrants exercised		$ (1,311,950)	$ (2,932,753)
Ending balance, RUSs			337,500
Ending balance			$ 1,297,812
Beginning balance, total (Shares)		70,703,428	64,741,443
Beginning balance, total (Values)		$ 154,029,746	$ 128,160,480
Issuance			6,250,000
Issuance		$ 14,138	$ 24,996,918
RSUs and warrants exercised			$ 1,311,146
Warrants expired		(525,000)	(288,015)
Warrants expired		$ (734,379)	$ (438,798)
Ending balance , total (Shares)		70,178,428	70,703,428
Ending balance , total (Values)		$ 153,309,505	$ 154,029,746
Common Stock [Member]
Class of Stock [Line Items]
Beginning balance, shares		69,840,928	62,371,275
Beginning balance		$ 151,997,555	$ 123,746,423
Issuance, shares			6,250,000
Issuance			$ 23,437,500
RSUs and warrants exercised , shares			1,219,653
RSUs and warrants exercised			$ 4,813,632
RSUs settled		$ 1,311,950
RSUs settled, shares		337,500
Ending balance, shares		70,178,428	69,840,928
Ending balance		$ 153,309,505	$ 151,997,555

Capital stock and warrants - Ad

Capital stock and warrants - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions	Nov. 18, 2019	Nov. 15, 2017	Apr. 30, 2020	Mar. 31, 2020	Nov. 30, 2018	May 31, 2018	Nov. 30, 2017	Aug. 31, 2017	Mar. 31, 2017	Mar. 12, 2020	Mar. 31, 2019	Mar. 12, 2018	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2018	Dec. 31, 2020	Dec. 31, 2019	Nov. 02, 2020	Nov. 14, 2019	Aug. 08, 2019	Dec. 31, 2018	Aug. 31, 2018
Class of Stock [Line Items]
Common Stock, No Par Value																$ 0	$ 0				$ 0
Class of warrants or rights warrants issued during the period						525,000	32,013	512,004	300,825
Class of warrants or rights number of shares for each unit of warrant held						1	1	1	1													1
Class of warrants or rights exercise price						$ 4	$ 3.50	$ 3.50	$ 2.30													$ 3.50
Share based compensation by share based payment arrangement equity instruments other than options vested shares																337,500	783,156
Class of warrants or rights expiry date								Aug. 8, 2019										May 2, 2020	Nov. 14, 2019
Class of warrants or rights outstanding				52,500													525,000				1,249,512
Restricted Stock Units (RSUs) [Member]
Class of Stock [Line Items]
Share based compensation by share based payment arrangement equity instruments other than options granted		1,611,316										315,000
Share based compensation award vesting rights percentage					50.00%						50.00%
Share based compensation by share based payment arrangement equity instruments other than options vested shares	600,656		10,000	42,500						285,000			132,500	25,000
Share based compensation number of common stock issued																14,137	1,559,418
Share based compensation by share based payment arrangment equity instruments other than options outstanding				52,500													337,500
Excercise Of Warrants [Member]
Class of Stock [Line Items]
Stock shares issued during the period on exercise of warrants														180,495	120,330
Issue In Connection With Business Acquistions [Member]
Class of Stock [Line Items]
Stock shares issued during the period on exercise of warrants														6,250,000
Sale of stock issue price per share													$ 3.75
Stock issued during the period shares new issues value														$ 23
Stock Issued As A Result Of Warrant Excercises [Member]
Class of Stock [Line Items]
Stock shares issued during the period on exercise of warrants													256,002
Class of warrants or rights outstanding													256,002
Class of warrants or rights expired																				256,002

Income Taxes - Summary of Recon

Income Taxes - Summary of Reconciliation of Income Tax Expense (Benefit) (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income attributable to common shareholders before income taxes	$ (26,148,454)	$ 13,163,526
Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%)	(6,929,340)	3,488,334
Increase (decrease) in income taxes resulting from
Stock-based compensation	396,528	942,013
State franchise tax, net of federal benefit	212,684	219,538
US tax rate differential	603,264	(400,948)
Return to provision adjustment	345,299	1,389,866
Other	(205,656)	(164,747)
Valuation allowance	(173,849)	(1,738,508)
Income tax expense (benefit)	(5,751,070)	3,735,548
U.S. State current tax expense (benefit)	(320,815)	1,643,043
U.S. Federal deferred tax expense (benefit)	(4,433,785)	2,688,571
U.S. State deferred tax expense (benefit)	(996,470)	(596,066)
Total Income Tax Expense Benefit	$ (5,751,070)	$ 3,735,548

Income Taxes - Summary of Rec_2

Income Taxes - Summary of Reconciliation of Income Tax Expense (Benefit) (Parenthetical) (Detail)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	26.50%	26.50%

Income Taxes - Summary of Compa

Income Taxes - Summary of Company's Deferred Tax Assets and Liabilities (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Deferred tax assets
Lease liabilities	$ 31,615,510	$ 33,474,270
Net operating losses	15,745,126	3,692,446
163(j) carryforward	5,934,846	1,458,105
Debt issuance costs	2,419,687	4,412,375
Capital acquisition costs	2,011,450	779,367
Other	3,409,797	9,430,097
Total deferred tax assets	61,136,416	53,246,660
Less: Valuation allowance (Canada)	(2,634,364)	(2,800,607)
Net deferred tax assets	58,502,052	50,446,053
Deferred tax liabilities
Right-of-use assets	(30,360,097)	(32,907,312)
Fixed assets	(14,973,077)	(12,400,551)
Goodwill	(10,664,325)	(8,392,326)
Other	(3,331,119)	(3,002,684)
Total deferred tax liabilities	(59,328,618)	(56,702,873)
Net deferred tax liabilities	$ (826,566)	$ (6,256,820)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Operating Loss Carryforwards [Line Items]
Effective Income Tax Rate Reconciliation, Percent	22.00%	(28.38%)
Deferred Tax Assets, Valuation Allowance	$ 2,634,364	$ 2,800,607
Operating Loss Carryforwards	68,755,558	16,226,326
Interest expense carryforward	24,670,177	$ 1,007,969
Operating Loss Carry forward Due 2036
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	19,742,894
Operating Loss Carrforward Do not Expire
Operating Loss Carryforwards [Line Items]
Operating Loss Carryforwards	$ 49,012,664

Stock-Based Compensation Option

Stock-Based Compensation Options - Summary of Stock Options (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of stock options - Outstanding Beginning	5,778,120	4,213,268
Number of stock options - Cancelled	(18,000)	(100,000)
Number of stock options - Granted	0	1,664,852
Number of stock options - Outstanding Ending	5,760,120	5,778,120	4,213,268
Number of stock options - Exercisable	3,978,218
Weighted average exercise price - Oustanding Beginning	$ 2.47	$ 2.18
Weighted average exercise price - Cancelled	3.74	3.74
Weighted average exercise price - Granted		3.29
Weighted average exercise price - Oustanding Ending	2.47	$ 2.47	$ 2.18
Weighted average exercise price - Exercisable	$ 2.03
Aggregate grant date fair value - Oustanding Beginning	$ 7,598,388	$ 5,353,785
Aggregate grant date fair value - Cancelled	(26,422)	(146,790)
Aggregate grant date fair value - Granted		2,391,393
Aggregate grant date fair value - Oustanding Ending	7,571,966	$ 7,598,388	$ 5,353,785
Aggregate grant date fair value - Exercisable	$ 4,990,924
Weighted average remaining contractual - Outstanding	5 years 3 months 18 days	6 years 3 months 18 days	7 years
Weighted average remaining contractual - Exercisable	5 years 2 months 12 days

Stock-Based Compensation Opti_2

Stock-Based Compensation Options - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Share based compensation percentage of maximum number of common shares reserved for issuance	10.00%
Share based compensation number of common stock reserved for issuance	7,017,842	6,984,092
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross	0	1,664,852
Share based compensation award vesting basis		1:1
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Exercise Price	$ 3.29	$ 3.29
Share based compensation award vesting rights percentage	33.00%	34.00%
Share based compensation share based payments award expiration period		7 years
Share based compensation share based payments fair value of stock granted		$ 1.4364
Share based compensation share based payments outstanding but not yet exercisable number	1,800,000	3,000,000
Share based compensation share based payments outstanding but not yet exercisable weighted average exercise price	$ 3.46	$ 3.49
Share based compensation share based payments outstanding but not yet exercisableweighted average remaining contractual term	5 years 6 months	6 years 4 months 24 days
Share Based Compensation Arrangement By Share Based Payment Award Options Outstanding But Not Yet Exercisable Weighted Average Grant Date Fair Value	$ 1,400,000	$ 2,200,000
Share Based Compensation Arrangement By Share Based Payment Award Options Vested Weighted Average Grant Date Fair Value	$ 0.9	$ 0.9
Share Based Compensation Arrangement By Share Based Payment Award Options Cancelled Vested Weighted Average Grant Date Fair Value	$ 26,000	$ 100,000
Share based compensation by share based payment arrangement total grant date fair value of stock options vested during the period	1,800,000	1,700,000
Stock-based options compensation expense	2,069,777	1,995,347
Unrecognized share based compensation expense	$ 1,089,614	$ 3,185,813
Unrecognized share based compensation expense, period for recognition	1 year 10 months 17 days	2 years 10 months 17 days
Share Based Compensation Arrangement By Share Based Payment Award Options Grants In Period Aggregate Grant Date Fair Value		$ 2,391,393

Stock-Based Compensation R_3

Stock-Based Compensation – Options - Summary of Fair Value Assumptions of Stock-based Option Awards (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Schedule Of Share Based Payment Award Stock Options Valuation Assumptions [Line Items]
Date of options grant	Nov. 18, 2019
Underlying stock price	$ 3.29
Exercise price	$ 3.29	$ 3.29
Term of options (years)	7 years
Volatility of underlying stock price	40.00%
Expected dividend yield on underlying stock	0.00%
Annual risk free interest rate	1.48%

Risk Management Arising From _3

Risk Management Arising From Financial Instruments - Summary of Estimated Fair Values of Other Non-Current Liabilities (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Instrument, Fair Value Disclosure	$ 429,826,997	$ 378,049,987
Two Thousand Twenty Five Senior Notes [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Instrument, Fair Value Disclosure	424,016,044
Amended May Two Thousand Nineteen loans payable [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Instrument, Fair Value Disclosure		360,596,500
Wesley Chapel Loan payable [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Instrument, Fair Value Disclosure	1,122,400	1,483,830
Subordinated Note Earn Out [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Instrument, Fair Value Disclosure		184,485
ADG Acquisition Earn Out [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Instrument, Fair Value Disclosure	$ 4,688,553	14,834,067
Derivative Financial Instruments, Liabilities [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Instrument, Fair Value Disclosure		$ 951,105

Risk Management Arising From _4

Risk Management Arising From Financial Instruments - Summary of Information Regarding the Change in Carrying Value of the Financial Instruments at Fair Value (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Subordinated notes payable – earn-out, Opening Balance	$ 184,485
Subordinated notes payable – earn-out, Ending Balance		$ 184,485
Derivative [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Opening Balance	951,105	16,014
Unrealized		967,119
Payment For Liabilities Change in Fair Value Of Financial Instruments	(4,805,000)
Realized	3,853,895
Ending balance		951,105
Subordinated Debt [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Subordinated notes payable – earn-out, Opening Balance	184,485	169,642
Unrealized		14,843
Payment For Liabilities Change in Fair Value Of Financial Instruments	(200,000)
Realized	15,515
Subordinated notes payable – earn-out, Ending Balance		184,485
ADG Acquisiton Earn Out [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Opening Balance	14,834,067
Issuance		14,748,022
Unrealized	(2,728,481)	86,045
Payment For Liabilities Change in Fair Value Of Financial Instruments	(4,688,553)
Realized	(2,728,480)
Ending balance	$ 4,688,553	$ 14,834,067

Risk Management Arising From _5

Risk Management Arising From Financial Instruments - Summary of Information Regarding the Carrying Value of Financial Instruments (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Fair Value Of Assets And Liabilities Carrying Value [Line Items]
Cash	$ 44,395,988	$ 23,388,916	$ 19,326,412
Accounts receivable	91,126,923	82,867,225
Accounts payable and accrued liabilities	34,233,142	26,262,225
Short-term portion of senior loans payable	405,698	3,705,952
Long-term portion of senior loans payable	389,580,046	336,276,370
Subordinated note – earn-out		184,485
Derivative financial instruments		951,702
Reported Value Measurement [Member]
Fair Value Of Assets And Liabilities Carrying Value [Line Items]
Cash	44,395,988	23,388,916
Accounts receivable	91,126,923	82,867,225
Financial assets measured at amortized cost	135,522,911	106,256,141
Accounts payable and accrued liabilities	34,233,142	26,262,225
Short-term portion of senior loans payable	405,698	3,705,952
Short-term portion of leases	12,610,462	11,066,293
Long-term portion of senior loans payable	389,580,046	336,276,370
Long-term portion of leases	135,262,436	126,399,101
Financial liabilities measured at amortized cost	572,091,784	503,709,941
Subordinated note – earn-out		184,485
ADG Acquisition – earn-out	4,688,553	14,834,067
Derivative financial instruments		951,105
Measured at fair value through profit or loss	$ 4,688,553	$ 15,969,657

Risk Management Arising From _6

Risk Management Arising From Financial Instruments - Schedule of Exposure to Interest Rate Risk and Effect on Other Comprehensive Income Loss (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Carrying value	$ 0	$ 338,534,995
Amended May 2019 Loans (originated in May 2019)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Carrying value		338,534,995
Syndicated Loans (n/a as settled in May 2019)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Carrying value		0
1% Decrease in Interest Rates [Member]
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates		1,180,247
1% Decrease in Interest Rates [Member] | Amended May 2019 Loans (n/a as settled in November 2020)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates	0
1% Decrease in Interest Rates [Member] | Amended May 2019 Loans (originated in May 2019)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates		1,180,247
1% Decrease in Interest Rates [Member] | Syndicated Loans (n/a as settled in May 2019)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates		0
1 % Increase In Interest Rates [Member]
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates		(1,979,043)
1 % Increase In Interest Rates [Member] | Amended May 2019 Loans (n/a as settled in November 2020)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates	$ 0
1 % Increase In Interest Rates [Member] | Amended May 2019 Loans (originated in May 2019)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates		(1,979,043)
1 % Increase In Interest Rates [Member] | Syndicated Loans (n/a as settled in May 2019)
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items]
Interest rates		$ 0

Risk Management Arising From _7

Risk Management Arising From Financial Instruments - Additional Information (Detail) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Fair Value Disclosures [Abstract]
Cash and Cash Equivalents fair value disclosure	$ 44,395,988	$ 23,388,916
Accounts Receivable fair value disclosure	91,126,923	82,867,225
Fair value concentration of risk foreign currency contracts	$ 0	$ 0

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Detail) - USD ($)	Nov. 01, 2020	Feb. 08, 2018
Pledgors [member]
Related Party Transaction [Line Items]
Debt instrument face amount		$ 500,000
Debt instrument interest rate stated percentage		6.00%
Debt instrument maturity date		Feb. 8, 2021
Common Stock [member] | Pledgors [member]
Related Party Transaction [Line Items]
Stock purchase during period		142,857
MRI Machine [member] | Officer of a Subsidiary [member]
Related Party Transaction [Line Items]
Purchase of asset form an entity	$ 400,000
Put and Call Option [member] | President and Chief Executive Officer and Certain Selling Security Holders of PMI [member] | Z Strategies Inc [member]
Related Party Transaction [Line Items]
Description of related party transaction terms		pursuant to the terms of a put and call option agreement made as of August 9, 2017 between Z Strategies Inc., a company controlled by the President and Chief Executive Officer, and certain selling security holders of PMI

Basic And Diluted Income (Los_3

Basic And Diluted Income (Loss) Per Share - Summary of Earnings Per Share Basic and Diluted (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Earnings Per Share [Abstract]
Net income (loss) attributable to common shareholders	$ (20,397,384)	$ 9,427,978
Weighted average common shares outstanding
Basic	70,101,618	66,528,051
Add: additional shares issuable upon exercise of employee stock options, warrants and restricted share units		2,066,938
Diluted	70,101,618	68,594,989
Net income (loss) per share
Basic and Diluted	$ (0.29)	$ 0.14
Employee stock options warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive	1,664,231

Financial Instruments Revalua_3

Financial Instruments Revaluation And Other Gains (Losses) - Operational Financial Instruments Revaluation and Other Gains (Losses) (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Operational Financial Instruments Revaluation And Other Gains Losses [Line Items]
Total Operational Financial Instruments Revaluation And Other Gains Losses Amount	$ (3,907,666)	$ (1,017,401)
Revaluation of Assets [Member]
Operational Financial Instruments Revaluation And Other Gains Losses [Line Items]
Gain (loss) on revaluation of ADG Acquisition – Earn-out (note 8)	5,456,961	(86,045)
Loss on disposal of property and equipment	$ (1,549,295)	$ (931,356)

Financial Instruments Revalua_4

Financial Instruments Revaluation And Other Gains (Losses) - Other Financial Instruments Revaluation and Other Gains (Losses) (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Other Financial Instruments Revaluation And Other Gains Losses [Line Items]
Other gains (losses)	$ 22,078,745	$ 1,805,816
Total Other Financial Instruments Revaluation and Other Gains Losses	(22,078,745)	(1,805,816)
Revaluation of Liabilities [Member]
Other Financial Instruments Revaluation And Other Gains Losses [Line Items]
Loss on debt revaluation	(18,278,845)	(829,208)
Loss on revaluation of derivatives	(3,853,895)	(967,119)
Other gains (losses)	$ 53,995	$ (9,489)

Revenue Information - Summary o

Revenue Information - Summary of Revenue Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	$ 243,981,183	$ 244,841,400
Other revenue	7,301,666	2,594,903
Revenues	251,282,849	247,436,303
Commercial
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	163,893,988	173,056,345
Medicare
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	28,449,283	28,849,651
Medicaid
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	7,889,878	7,421,432
Attorney
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	24,271,130	14,784,804
Workers comp
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	9,960,660	10,569,156
Other patient revenue
Disaggregation of Revenue [Line Items]
Service fees - net of allowances and discounts	$ 9,516,244	$ 10,160,012

Cost Of Operations, Excluding_3

Cost Of Operations, Excluding Depreciation And Amortization - Summary of Cost of Goods and Services Excluding Depletion Depreciation And Amortization (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	$ 197,803,388	$ 187,802,601
Employee compensation
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	84,038,371	85,899,654
Reading fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	37,817,457	35,243,843
Rent and utilities
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	30,203,346	26,332,049
Third party services and professional fees
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	21,706,906	19,084,397
Administrative
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	12,875,606	12,459,281
Medical supplies and other
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]
Cost of operations, excluding depreciation and amortization (note 22)	$ 11,161,702	$ 8,783,377

Settlement Costs And Other (R_2

Settlement Costs And Other (Recoveries) - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Settlement costs and other (recoveries)	$ 2,324,151	$ (1,881,233)
Settlement cost related to four vendors	1,100,000
Federal Health Care Programs to Subsidiaries or Revenue Practice [Member]
Amount related to a settlement of government investigation	$ 800,000
Loss Contingency Settlement Maturity Date	Jan. 31, 2021

Non-Controlling Interests - Sum

Non-Controlling Interests - Summary of Effective Ownership Interest Held in the Non-Wholly Owned Entities (Detail) - Non Wholly Owned Entities [member]	Dec. 31, 2020	Dec. 31, 2019
Phoenix Imaging, LLC [member]
Noncontrolling Interest [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	60.00%	60.00%
Preferred Imaging of Amarillo, LLC [member]
Noncontrolling Interest [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	57.00%	57.00%

CARES Act - Additional Informat

CARES Act - Additional Information (Detail) - USD ($)	1 Months Ended
	Dec. 31, 2020	Apr. 30, 2020
Coronavirus Aid Relief And Economic Security Act [Line Items]
Accrued payroll taxes	$ 1,346,088
Grant [Member] | Akumin Inc [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Proceeds from contributions from government		$ 1,100,000
Additional contributions received from government	4,100,000
Coronavirus Aid Relief And Economic Security Act [Member] | Social Security Tax [Member] | Accounts Payable and Accrued Liabilities [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Accrued payroll taxes	1,300,000
Coronavirus Aid Relief And Economic Security Act [Member] | Social Security Tax [Member] | Accrued Payroll Taxes [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Accrued payroll taxes	$ 2,700,000
Centers For Medicare And Medicaid Service [Member] | Expanded Accelerated And Advance Payments Program [Member] | Akumin Inc [Member]
Coronavirus Aid Relief And Economic Security Act [Line Items]
Amount received as accelerated medicare payments		$ 3,100,000

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions	Mar. 09, 2021	Mar. 01, 2021	Dec. 31, 2020	Dec. 31, 2019	Feb. 11, 2021
Subsequent Event [Line Items]
Shared based compensation arrangements by share based payments award options granted in period			0	1,664,852
Share based compensation arrangements by share based payments award expiration period				7 years
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage			33.00%	34.00%
Restricted Stock Units (RSUs) [Member]
Subsequent Event [Line Items]
Shared based compensation arrangements by share based payment award shares issued in period			14,137	1,559,418
Subsequent Event [Member]
Subsequent Event [Line Items]
Total estimated equity investments		$ 8
Payments for purchase of warrants		$ 0.4
Percentage of warrants or rights to be acquired in the targets common equity		2.40%
Target percentage of equity investment ownership percentage		34.50%
Subsequent Event [Member] | Private Placement [Member] | Artificial Intelligence Business [Member]
Subsequent Event [Line Items]
Total estimated equity investments		$ 4.6
Subsequent Event [Member] | Private Placement [Member] | Seven Percent Senior Secured Notes Due November 2025 [Member]
Subsequent Event [Line Items]
Debt instrument face amount					$ 75
Debt instrument interest rate stated percentage					7.00%
Subsequent Event [Member] | Restricted Stock Units (RSUs) [Member] | Non Executive Director [Member] | Twenty Twenty One Compensation [Member]
Subsequent Event [Line Items]
Shared based compensation arrangements by share based payments non option equity instruments granted	84,032
Subsequent Event [Member] | Restricted Stock Units (RSUs) [Member] | Certain Employees [Member] | Equity Bonus Awards [Member]
Subsequent Event [Line Items]
Shared based compensation arrangements by share based payments non option equity instruments granted	645,000
Subsequent Event [Member] | Restricted Stock Units (RSUs) [Member] | Signing Bonus [Member] | Executive Officer [Member]
Subsequent Event [Line Items]
Shared based compensation arrangements by share based payment award shares issued in period	50,000
Subsequent Event [Member] | Vested And Settle For Common Shares One Year After Date Of Grant [Member] | Restricted Stock Units (RSUs) [Member]
Subsequent Event [Line Items]
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage	50.00%
Subsequent Event [Member] | Remaining Vested And Settle For Common Shares Two Years After Date Of Grant [Member] | Restricted Stock Units (RSUs) [Member]
Subsequent Event [Line Items]
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage	50.00%
Subsequent Event [Member] | Stock Option Plan [Member]
Subsequent Event [Line Items]
Share based compensation arrangements by share based payments options granted wit an exercise price	$ 3.58
Share based compensation arrangements by share based payments award expiration period	7 years
Subsequent Event [Member] | Stock Option Plan [Member] | Consultants Of The Company [Member] | Equity Bonus Awards [Member]
Subsequent Event [Line Items]
Shared based compensation arrangements by share based payments award options granted in period	70,000
Subsequent Event [Member] | Grant Vest One Year After The Date Of Grant [Member]
Subsequent Event [Line Items]
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage	34.00%
Subsequent Event [Member] | Grant Vest Two Years After The Date Of Grant [Member]
Subsequent Event [Line Items]
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage	33.00%
Subsequent Event [Member] | Remaining Grant Vest Three Years After The Date Of Grant [Member]
Subsequent Event [Line Items]
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage	33.00%