Submit Online Claim
All receipts must clearly indicate the date, the amount of purchase including taxes, for whom the purchase was made and what item/service was purchased.
Credit card till receipts by themselves are not sufficient documentation. e.g. We require the actual prescription receipt with drug number, issuing doctor etc or a summary of prescriptions signed by the pharmacist.
Submissions should not have a credit card till receipt covering any information. We would only require the credit card till receipt if the submission did not show payment. Normally the credit card till receipt is not required. See Examples.
| Date of Service/Purchase |
Patient Name | Description of expense (Select from Item Menu) |
Amount Paid Format: 0.00 |
Drag and Drop or Upload File Acceptable File Types: PDF, PNG, JPEG, JPG, DOC, DOCX |
Actions |
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Total Claimed: $0.00 |
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