1 Start 2 Recipient 3 Location & Notes 4 Payment & Finalize Submit your Prescription Welcome! We will guide you through the submission process in a few short steps. Start Set your recipient Recipient Status Myself Dependant First name * Surname * Date of birth * Gender * Select Male Female Other Prefer Not to Say Email * Mobile Number * Back Next: Location & Notes Location Details Country * County, City or Town * Additional Information Additional notes (Optional) Back Next: Payment Option Payment Option Select a Payment option Self Pay Smart MTIBA CIGNA Slade360 LCT Africa Select Insurance Company Please select... APA INSURANCE Britam MADISON Insurance M Minet Self Pay Details Payment Method * Select Method Cash on delivery Mpesa Card Payment Mpesa Mobile Number (for STK Push) * Card Number * Expiry Date (MM/YY) * CVV * Upload Prescription * Max file size: 5MB You have opted to self pay. Please click/touch the button below to complete the process. (Once your Prescription has been Verified and Processed you directed to refresh the site to Checkout and Pay) Back Complete Submission MTIBA Treatment Code MTIBA Treatment Code * How to obtain the treatment code: Dial *253# (Safaricom, Airtel, Telkom on the number registered on MTIBA). Enter M-TIBA Pin (Press 1 if you have forgotten your pin). Press 1- To initiate a treatment. Select Recent Clinic (Gathimaini Pharmacy). Select Patient to be treated. Select the Cover to use. Press 1 to authorize. You will receive an in-app message and SMS with the transaction number/Treatment Code. Back Complete Submission Document Uploads Click/Touch to upload Prescription Click/Touch to upload Claim Form Click/Touch to upload Insurance Card Note: Prescription upload is required. (On Successful Submission of the above Documents, You will be advised further via Phone Call on how to procced). Back Submit Documents
