Record Storage and Retention Program-Retroactive Reimbursement-Paper Storage (Aug 1, 2023 launch)

RECORDS STORAGE AND RETENTION PROGRAM

Retro Active Reimbursement Form-Paper Records Storage FY 2023-2024
Retroactive Reimbursement Form for

PAPER RECORDS Storage

The purpose of the Records Storage and Retention Program is to provide members with financial support to offset the costs of midwifery records storage and retention.

ELIGIBILITY:

All registered MABC members residing in B.C. with records created in B.C. will be eligible to apply for this funding.

Please review the details in the form to ensure you are completing the correct document (refer back to the Members website as needed).

Have you taken action and incurred the costs of paper records storage? If you have your receipt, you can apply for retroactive funding:
Contact Information
Full Name*

First NameLast Name
Address of Practice for which records associated*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Type of reimbursement requested*

Paper Record Storage
Date cost incurred*

YearMonthDay

RECORD STORAGE AND RETENTION PROGRAM

Retro Active Reimbursement Form-Paper Record Storage FY 2023-2024
Total reimbursement amount requested for transfer, digitalization, and storage of midwifery records*
Please upload your receipts #1

Cancelof
Please upload your receipts # 2

Cancelof
Please upload your receipts # 3

Cancelof

RECORD STORAGE AND RETENTION PROGRAM

Retro Active Reimbursement Form-Paper Record Storage FY 2023-2024
I confirm that:*

The information I have provided on this form is true and accurate
Signature*

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