Get Canada C774 2016-2026

The Canada C774 form is essential for submitting pharmacy prescription invoices related to work-related injuries or illnesses. This guide will provide you with a clear, step-by-step approach to completing the form online, ensuring you can efficiently manage your claims.

Follow the steps to accurately complete the Canada C774 form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin by entering the WCB claim number at the top of the form. This number is crucial for processing your claim.
3. Fill in the provider’s invoice number to ensure proper tracking and payment of your claim.
4. Complete the worker's information section with their full name, address, personal health number, and date of birth.
5. Input the details for each prescription dispensed, including the date dispensed, quantity, Drug Identification Number (DIN), and description of the drug.
6. Record the date of the accident as well as the prescribing doctor’s name in the designated fields.
7. List the amounts billed for each drug, ensuring that the total amount billed is clearly indicated at the bottom of the form.
8. Sign and date the form, then provide the name and address of the pharmacy to whom the fee is payable, along with their fax and telephone number.
9. Review all information for accuracy before submitting. Save the changes, and consider downloading or printing a copy for your records.
10. Submit the completed form either by fax or mail as per the provided instructions.

Complete your Canada C774 form online today to ensure your claims are processed swiftly.