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
Attached Files
File | Action |
---|---|
RAMQ-RxPaymentAuth-3996.zip | Download |