Families of children enrolled in BC's At Home Program Medical Benefits use this 2-page request to have medical and incontinence supplies funded. The recommending medical professional lists each item with its size, amount and frequency, and explains how the supplies relate directly to the child's specific diagnosis. Once approved, supplies can be ordered monthly from the program's Product Distribution Centre.
The parent or guardian provides the family and child details, and the medical professional recommending the supplies, such as a physician or nurse practitioner, completes the supply lists, justification and professional information, then signs the certification.
Download the current version from the source each time; forms change without notice.
At Home Program Request for Medical Supplies
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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The medical professional recommending the supplies, such as the child's physician or nurse practitioner. The signature certifies that the information is correct, that they assessed the child's medical needs, and that they accept responsibility for recommending the products requested. Their name, position title and contact details go in the Medical Professional Information section.
Yes. The request is for children already found eligible for At Home Program Medical Benefits, which starts with the At Home Program Application (CF2158) and, for most children, an in-home assessment of eating, dressing, toileting and washing. Medical benefits are pre-approved, and approved supplies are then ordered monthly from the Product Distribution Centre.
BC's At Home Program says its medical benefits request forms will not work in Google Chrome. Download the fillable PDF and open it in a PDF reader to complete the supply tables, incontinence details, justification and signature fields, then email, mail or fax it to the Medical Benefits Branch.