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How to use or fill out Hospital Claim Formexisting 20190404
- Click ‘Get Form’ to open it in the editor.
- Begin with Part I, where the patient or their legal guardian must fill in the mandatory fields. Start by entering the Patient’s Membership Number in BLOCK letters.
- Next, provide the Name of Employer if applicable, followed by the Subscriber/Employee's name and the Patient's name if different. Ensure names are formatted correctly with spaces between words.
- Fill in the Occupation field if relevant, and then specify the Date of Hospitalisation or Day Case Surgery.
- If hospitalisation was due to illness, describe symptoms leading to hospitalisation and include dates when symptoms appeared.
- For accidents, provide details such as date, time, place of the accident, and a description of how it happened along with injury specifics.
- Complete any additional sections regarding previous consultations and ensure all required signatures are provided at the end of the form.
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