Form HTLH3497 Application for Pharmacare Plan G - British Columbia, Canada

Form HLTH 3497 Instructions

The Plan G Form is presented on two pages and consist of several parts, which include the following:

1. Information About the Patient . The first part of the document is supposed to be filled in and signed by the individual themselves. They are supposed to designate their full name, address, telephone number, date of birth, and other identifying information. Here, they can also learn how the information they presented in the document will be used.
2. Prescribing Physician's Certification . This section of the form is supposed to be filled in and signed by a prescribing physician or a nurse practitioner. They can describe the individual's condition, sign the document, fill in their full name, telephone number, and the date when the form was signed. After they have finished with their part, they can submit the document to their local mental health and substance use center, Child and Youth Mental Health (CYMH) center, or the mental health contact at their local health authority.
3. Centre's Approval . After one of the centers indicated in the previous part has received the application, they are supposed to approve it. This part requires the director of the center to sign the document, and designate their full name. In addition to this, this part should also include information about the center's name and location. According to the guidelines included in the form, when this section is completed, the center must fax this form to Health Insurance British Columbia.
4. Exceptional Coverage . This type of coverage is available for new residents of British Columbia who are waiting to be enrolled in the British Columbia Medical Service Plan. Exceptional Plan G coverage only lasts for three months and cannot be prolonged.
5. PharmaCare Authorization . If the individual is eligible for the Exceptional Plan G Coverage, Pharma Care is supposed to approve it and state its period.