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picture1_Spread Sheet Blank 30714 | C537a Item Download 2022-08-08 03-08-03


picture2_Spread Sheet Blank 30714 | C537a Item Download 2022-08-08 03-08-03 picture3_Spread Sheet Blank 30714 | C537a Item Download 2022-08-08 03-08-03

 139x       Filetype DOCX       File size 0.05 MB       Source: www.wcb.ab.ca


File: Spread Sheet Blank 30714 | C537a Item Download 2022-08-08 03-08-03
C537A PROSTHETIC AND ORTHOTIC SERVICES P.O. BOX 2415 Unlisted Device/Service Calculations Worksheet EDMONTON, AB T5J 2S5 FAX: 780-427-5863 1-800-661-1993 WCB Claim Number WORKER DETAILS     &ensp ...

icon picture DOCX Filetype Word DOCX | Posted on 08 Aug 2022 | 2 years ago

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...Ca prosthetic and orthotic services p o box unlisted device service calculations worksheet edmonton ab tj s fax wcb claim number worker details surname first name initial date of birth yyyy mm dd accident please use this calculation to determine pricing for devices note socks sheaths or sleeves only enter the invoice price into line b otherwise leave space blank a should be completed not both manufacturer quote must attached code item description quantity if is in usd bank canada exchange rate from amounts cad mark up excluding x any taxes on exclude show tax d c shipping as per actual cost paid e labour closest hour multiplied by indicate time needed hrs portion self calculated total amount address whom fee payable print provider signature billing phone reference document may examined person with direct interest that under review submitted within months eligible payment rev apr page...
								

							

						
	
												
				
					
					
					
			
					
				
				
		
	

	
		





	

	
				

						

						
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										Category:  Uncategorized / Uncategorized 
										
Posted on: 08 Aug 2022 | 2 years ago
										
										
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Filetype: DOCX
										
File size: 0.05 MB
										
Views: 139x
										
Uploaded by:
										
										
										

										Wan learn
											

												Wan learn