Get Customer Reimbursement Form R4 - Skcdc

This guide provides detailed instructions for completing the Customer Reimbursement Form R4 - SKCDC online. It aims to assist users in accurately filling out each section to ensure a smooth reimbursement process.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of the trip in the designated field, ensuring you use the correct format.
3. Fill in the name of the customer who had the appointment. Make sure to include the full name for clarity.
4. Provide the home address of the customer, including street, city, state, and zip code.
5. Input the customer's phone number in the specified field for contact purposes.
6. Record the name of the doctor or provider who attended to the customer.
7. Complete the full address of the provider, ensuring accuracy for reimbursement verification.
8. Document the starting mileage when leaving the customer's home in the specified section.
9. Write the trip ID number if applicable, and log the ending mileage after dropping the customer at the provider.
10. For the return trip home, input the starting mileage and ending mileage, along with the trip ID number again.
11. List the name and address of the person to be reimbursed, completing all relevant fields.
12. Fill in the reimbursement ID, and check the box if this is a new name or address.
13. Sign and date the form, confirming the appointment was kept and all information is accurate.
14. Save any changes made to the form, and choose to download, print, or share the form as needed.

Complete your reimbursement forms online to ensure timely processing and avoid delays.