Forms

Forms for B.C. Residents

• Register for Fair PharmaCare Online
• Fair PharmaCare Registration Form - English ^{(PDF 557K)}
• Fair PharmaCare Registration Form - Français ^{(PDF 560K)}
• Fair PharmaCare Consent Form Request
• Confirmation of Fair PharmaCare Assistance Request
• Income Review Application ^{(PDF 154K)}

Forms for B.C. Health Professionals

For Pharmacists

• Rural Incentive Program Application ^(PDF 522K)
• Frequent Dispensing Authorization ^{(PDF 543K)}
• Compound Costing Worksheet ^{(PDF 955K)}

For Physicians

• Special Authority Request Forms
• No Charge Psychiatric Medication Program (Plan G) application
  (for physician/Mental Health Service Centre use)
• BC Palliative Care Benefits Program Application^{(PDF 372K)} – Updated January 2013

For Prosthetic and Orthotic Suppliers

• Orthotic benefits (HLTH 5400)—form^{(PDF 652K)} and instructions^{(PDF 412K)}
• Orthotic benefits (HLTH 5401)—invoice^{(PDF 535K)} and instructions^{(PDF 238K)}
• Prosthetic benefits (HLTH 5402)—form^{(PDF 597K)} and instructions^{(PDF 332K)}
• Prosthetic benefits (HLTH 5403)—invoice^{(PDF 536K)} and instructions^{(PDF 175K)}
• Prosthetic benefits: Non-Limb (HLTH 5404)—form^{(PDF 530K)} and instructions^{(PDF 250K)}