Form 25P - NC Industrial Commission - NC 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Employee’s Name and Employer's Name in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the addresses for both the employee and employer, including city, state, and zip code. This helps in identifying the parties involved.
4. Input the Employee Code, Carrier Code, and IC File Number. These identifiers are essential for tracking your claim.
5. Provide details about the drug store, including its name, address, and telephone number. This information is necessary for reimbursement processing.
6. List each drug along with its prescription number and total amount charged. Make sure to attach receipts as they are required for verification.
7. Sign the form to certify that the drugs listed relate to your workers' compensation injury. Ensure you also check whether reimbursement should go directly to you or the drug store.

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