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Get Wsib Medication Reimbursement Form

St with your claim number and ask that your prescription be processed through the WSIB on-line system. Instructions for Completion A. Worker Information Last name First name Current address City Initials Province Postal Code New address? yes Home phone ( Work phone ) ( B. Medication Information 1. Please print clearly in black ink. 2. Complete sections A, B, & C in full. 3. Send all original pharmacy receipts (not photocopies) with this form. Please write your claim number on eac.

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