Interpreter Invoice Form

Thank you for choosing to submit your Interpreter Invoice through the new and improved ProCare form. If you require additional assistance, call 866.941.7878 or email our form support team.

Interpreter Invoice Form

Step 1 of 2

Interpreter Details
Date of Service*
MM slash DD slash YYYY
ProCare's PO Number*
Patient's Name*
Appointment Status*
Interpreter's Name
Certification Number
Interpreter Starting Address

*Required field. You must enter valid information for the fields required for your form to submit.
**For California Certified services, these fields are required.
Start Time*

: Hours

Minutes
End Time*

: Hours

Minutes
Interpretation Hours**
Interpretation Rate*
Mileage Units*
Mileage Rate*
Other Quantity*
Other Rate*
Other Description
One (1) hour min. is required for hours. Please fill out all fields, even if the value is zero.
Subtotal Amount ($)

Provider Information
Provider ID*
Provider Name
Provider Phone
Provider Email*
Additional Comments
Comments
Next Office Visit
Next Office Visit Date
MM slash DD slash YYYY
Appointment Time

: Hours

Minutes
Facility Name
Facility Phone
Facility Address
Street Address Address Line 2 City State ZIP Code
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File
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Max. file size: 32 MB.
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Tel:	866.941.7878
Fax:	813.769.3883

Tel:	866.941.7878
Fax:	813.769.3883

Interpreter Invoice Form

Step 1 of 2

Interpreter Details

Provider Information

Additional Comments

Next Office Visit

Upload Files