Get Bon De Commande De Lentilles - Service-public-particuliers - Service-public-particuliers Gouv

The BON DE COMMANDE DE LENTILLES is an essential document for individuals seeking reimbursement for contact lenses. This guide provides a clear and step-by-step approach to filling out the form online, ensuring a smooth submission process.

Follow the steps to successfully complete the BON DE COMMANDE DE LENTILLES online.

1. Press the ‘Get Form’ button to access the document and open it in the editor.
2. Begin by attaching the required prescription document from your optician.
3. In the section labeled 'LE BENEFICIAIRE EST SOIGNE,' select the appropriate box based on your situation: if you are a victim of a work accident, a victim of an accident caused by a third party, or a beneficiary of medical benefits.
4. Fill out the section for 'LE BENEFICIAIRE DES SOINS' with the full name and first name of the individual receiving care, along with their date of birth.
5. Enter the data for 'L’ASSURE' by providing the insurance number, and the assured person's full name and first name, along with their address.
6. In the 'DEVIS' section, write the name of the prescribing physician.
7. Complete the 'FOURNITURES' section by providing details about the contact lenses, including the unit price, quantity, and total price for monthly disposable lenses.
8. Document the date of prescription clearly in the designated area.
9. Include any additional relevant costs in the 'BASE DE REMBOURSEMENT,' mentioning any annual fees or extra lenses.
10. Ensure that the total invoice amount is clearly stated.
11. Lastly, sign and date the form at the bottom, confirming that the information is accurate and complete.
12. After completing the form, you can save changes, download, print, or share the document as needed.

Complete your documents online for hassle-free processing.