Get Pharmacy Invoice Template

The Pharmacy Invoice Template is a crucial document used for billing pharmaceutical services, especially in the context of work-related injuries. This guide aims to provide clear and concise instructions for users on how to accurately fill out the template online.

Follow the steps to complete the Pharmacy Invoice Template online

1. Press the ‘Get Form’ button to obtain the Pharmacy Invoice Template and open it in your editing tool.
2. In the first section, enter the WCB claim number. This number is essential for linking the invoice to the worker’s compensation claim.
3. Complete the Provider’s Invoice Number field with the specific invoice number for your records.
4. Fill in the worker's address, including their surname, first name, initials, street address, city/town, province, and postal code.
5. Input the worker's personal health number and date of birth for identification purposes.
6. In the section for dates, fill in the date the prescription was dispensed, formatted as YYYY/MM/DD.
7. Record the quantity and DIN number for each prescribed medication.
8. Provide a description of each drug prescribed.
9. Enter the prescribing doctor’s name in the designated field.
10. List the amount billed for each medication and calculate the total amount billed, ensuring accuracy.
11. Sign the form in the Provider’s Signature field and enter the date submitted.
12. Finally, fill out the name and address of the pharmacy where the fee is payable, along with their fax and telephone numbers.

Complete your Pharmacy Invoice Template online today to ensure efficient processing.