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Claim Form – Program Regarding Bandages and Compression Garments Used to Treat Lymphedema

Updated on

 13 May 2021

This form is used to apply for a reimbursement of the cost of supplies purchased from a provider that has not signed an agreement with RAMQ. Must be accompanied by the original invoices and proofs of payment, as well as a medical prescription in the case of a first application.

Form 4258

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