Get Programme Fdral De Sant Intrimaire Pfsi Formulaire D

Filling out the PROGRAMME FÉDÉRAL DE SANTÉ INTÉRIMAIRE PFSI FORMULAIRE D is essential for providers seeking registration under the Federal Interim Health Program. This guide will provide you with clear and straightforward instructions on how to accurately complete the form online, ensuring all necessary information is included correctly.

Follow the steps to fill out the PROGRAMME FDRAL DE SANT INTRIMAIRE PFSI FORMULAIRE D online.

1. Use the ‘Get Form’ button to obtain the FORMULAIRE D and open it in your document editor.
2. In Part A, provide the information about the supplier. Fill in your name, company name, and address. Make sure to use uppercase letters when entering this information. Include your phone number, postal code, fax number, email address, and preferred language (French or English). If there is a different contact person, provide their details as well.
3. In the same part, if the mailing address or the address for receiving checks differs from the business address, you will need to specify that information. Fill in the alternate address details including the city, province or territory, postal code, phone number, and email address.
4. In Part B, specify the type of supplier or specialty, such as physician, dentist, or physiotherapist. If applicable, provide the designated physician number and the Blue Cross Medavie provider number. Include the name of the licensing association or body and your license or registration number. Also, indicate the province or territory of registration.
5. When you reach the attestation section, ensure that you confirm that all provided information is accurate, current, and complete. Remember that providing incorrect information can lead to the rejection of your application.
6. Sign the form by printing your name in uppercase characters, adding your signature, and dating the document.
7. Finally, follow the submission instruction to send the completed FORMULAIRE D along with the attestation and any other required documents via fax, email, or postal service as specified.

Begin your application process by filling out the PROGRAMME FDRAL DE SANT INTRIMAIRE PFSI FORMULAIRE D online today.