Note: WCB is the primary insurance carrier for all - wcb ab 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the WCB Claim Number and Provider’s Invoice Number at the top of the form. This information is crucial for processing your claim.
3. Fill in the Worker’s Address, including Surname, First Name, Initial, Street, City/Town, Province, and Postal Code. Ensure all details are accurate to avoid delays.
4. Input the Personal Health Number and Date of Birth of the worker. This information helps verify identity and eligibility.
5. For each medication dispensed, enter the Date Dispensed, Quantity, DIN Number, Description of Drug, Date of Accident, Prescribing Doctor's name, and Amount billed. Be thorough to meet invoice requirements.
6. Calculate and enter the Total Amount Billed at the bottom of the form. Double-check your calculations for accuracy.
7. Finally, ensure that you sign and date the form before submission. Include your pharmacy's name and contact details as required.

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