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How to fill out the Form 25p online
Filling out the Form 25p is essential for documenting drug charges related to a workers' compensation injury. This guide provides clear and detailed instructions for completing the form online to ensure accuracy and compliance.
Follow the steps to complete the Form 25p online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the employee’s name in the designated field, ensuring correct spelling for identification purposes.
- Fill in the employer's name and their address, including city, state, and zip code.
- Provide the employer's Federal Employer Identification Number (FEIN) and the employee's Social Security Number in the respective fields.
- Input the drug store's name and complete their address details, ensuring to include the city, state, and zip code.
- Document the details of the drugs and the prescription number as provided by the physician.
- Record the total amount charged for the drugs in the specified space.
- Sign the form to certify that the drugs listed are related to the workers' compensation injury.
- Indicate whether the reimbursement is to be made to the employee or drug store by selecting 'Yes' or 'No' in the provided options.
- Finally, review the form for any missing information, then save your changes, and consider downloading, printing, or sharing the document as necessary.
Complete your Form 25p online today to ensure timely processing of your drug charges.
To file a workers' comp claim in North Carolina, first report your injury to your employer, ensuring they document the occurrence. Next, complete the necessary forms, particularly your Form 25p, and submit them to the insurance provider. Utilizing platforms like uslegalforms can streamline this process, helping you access the forms you need and ensuring timely submission.
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