Who should fill out and sign the “Primary Insured Certification” section of the rebate request form?
The “Primary Insured Certification” section of the rebate request form is filled out and signed by the person responsible for the out-of-pocket cost for the dose of GARDASIL administered to the patient listed on the form. This person could be the patient, if the private health insurance is in the patient’s name and the patient is personally responsible for the out-of-pocket cost, or someone else (such as a parent, legal guardian, or spouse) if the private health insurance is not in the patient’s name.
Related Questions
- Who should fill out and sign the "Health Care Professional Certification" section of the rebate request form?
- Who should fill out and sign the "Primary Insured Certification" section of the rebate request form?
- Who should fill out and sign the "Patient Certification" section of the rebate request form?
