Get Plan G Form

The Plan G Form is essential for individuals seeking coverage for prescribed psychiatric medications through PharmaCare. This guide will provide step-by-step instructions to help you complete the form online efficiently and accurately.

Follow the steps to fill out the Plan G Form online:

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Fill in the patient's name, phone number, address, postal code, and Personal Health Number (PHN) in the designated fields. Ensure the name and PHN are accurate as these are mandatory.
3. Enter the patient's birthdate using the format YYYY/MM/DD. Confirm that this information is correctly inputted.
4. Indicate whether the cost of prescribed psychiatric medication is a significant barrier for the patient. If so, check the applicable box.
5. Confirm that the patient meets the financial qualification requirements for Plan G. If applicable, check the relevant box.
6. Obtain the patient's signature in the 'Patient Signature' box and input the date signed. This step is mandatory.
7. The prescribing physician or nurse practitioner must select the most applicable options under part B and provide necessary signatures along with their information.
8. If required, ensure to provide details in part C for the mental health center's or health authority's use, including their approval and signature.
9. For the prescribing physician or nurse practitioner, ensure all required fields in each section are completed accurately. Then, fax the completed form as directed.
10. Once all sections are filled out, save the changes, download the document, and if necessary, print or share the form as needed.

Complete your documentation online now to ensure a smooth application process for Plan G coverage.