RAMQ Rx Payment Authorization – form 3996

RAMQ Rx Payment Authorization - form 3996

This is the RAMQ Medication Payment Authorization form, available at https://www.ramq.gouv.qc.ca/sitecollectiondocuments/professionnels/formulaires/3996.pdf

Programming features: Autosign, Date reformatting, Prefilled fax number, Y/N X-Box

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