Get the free Your 2016 Prescription Drug List - Columbia College
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OMB No. 12100149
(expires 6302023)PART A: General Information
When key parts of the health care law take effect
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How to fill out your 2016 prescription drug
How to fill out your 2016 prescription drug
01
Gather all your prescription drug receipts from the year 2016.
02
Look for the prescription drug claim form provided by your insurance company.
03
Fill out the form with the required information, such as your name, policy number, and contact details.
04
List each prescription drug you purchased in 2016 separately on the form.
05
Include the date of purchase, name of the drug, dosage, and quantity for each medication.
06
Attach copies of the receipts for each prescription drug to the form.
07
Make sure to double-check that all the information on the form is accurate and complete.
08
Submit the completed form and receipts to your insurance company according to their designated method (mail, fax, or online submission).
Who needs your 2016 prescription drug?
01
Anyone who had prescription drug expenses in the year 2016 and wants to claim reimbursement from their insurance company.
02
Individuals who have insurance coverage for prescription drugs and have incurred eligible expenses throughout the year.
03
Patients who want to ensure they receive the maximum allowable reimbursement for their prescription drug purchases in 2016.
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What is your prescription drug list?
The prescription drug list is a document that includes all the medications prescribed to an individual.
Who is required to file your prescription drug list?
Healthcare providers or pharmacies are required to file the prescription drug list.
How to fill out your prescription drug list?
To fill out the prescription drug list, providers must include all prescribed medications along with dosage and frequency.
What is the purpose of your prescription drug list?
The purpose of the prescription drug list is to keep track of all medications prescribed to an individual for proper management of their health.
What information must be reported on your prescription drug list?
The prescription drug list must include the name of the medication, dosage, frequency, and the prescribing healthcare provider.
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