ILLNESS ACCIDENT MEDICAL REPORT PLEASE USE BLOCK - expatinsurance 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'Policy number' at the top of the form. This is essential for identifying your insurance coverage.
3. In the 'INFORMATION ABOUT THE PATIENT' section, enter the patient's first name, last name, address, postal code, city, date of birth, and gender. Ensure all details are accurate and in block capitals.
4. Provide contact information including email and telephone numbers. Remember to include country codes for mobile and telephone entries.
5. Next, move to 'DOCTOR’S DETAILS AND TREATMENT INFORMATION'. Fill in the doctor's name, address, postal code, city, country, telephone number, and email.
6. Indicate when the patient first became aware of their symptoms and describe those symptoms along with any diagnosis provided.
7. Answer whether the patient has previously suffered from similar complaints and provide a brief description of any treatment already given.
8. If applicable, complete the 'IN CASE OF HOSPITAL ADMISSION' section with admission dates and hospital details.
9. Finally, ensure that you declare your role as the patient's doctor by signing and dating at the bottom of the form.

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