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How to use or fill out Compliance Packaging Form - providerConnect with our platform
- Click ‘Get Form’ to open the Compliance Packaging Form - providerConnect in the editor.
- Begin with Section 1: Plan Member Declaration. Enter the Plan Member Name and GSC ID #. Specify the dispensing frequency in days and acknowledge that compliance packaging is not child-safe by signing at the bottom.
- Proceed to Section 2: Pharmacist Declaration. The pharmacist should indicate their professional judgment regarding the need for compliance packaging, selecting applicable reasons and providing supporting information in the designated space.
- Complete Section 3: Form Submission Instructions by ensuring all sections are filled out completely. Follow the instructions to fax the form to Green Shield Canada’s Drug Special Authorization Department.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4.3 Satisfied (33 Votes) |
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