Radiation Exposure Compensation Act Downwinder Claim 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Policy Number at the top of the form. This is essential for identifying your claim.
3. Fill in the Policyholder Information section with your last name, first name, middle initial, date of birth, and contact number. Ensure all fields are completed accurately.
4. Provide your home address details including city, state, and zip code. If this is a permanent address change, mark the corresponding checkbox.
5. In the Patient Information section, enter the patient's last name, first name, date of birth, and select their sex. Specify their relationship to the policyholder.
6. Indicate treatment dates and check all applicable wellness exam boxes for tests received. Be sure to only mark those that apply.
7. Complete the Physician's information including their name, phone number, and address. This validates your claim.
8. Finally, sign and date the form at the bottom before submitting it via fax or mail as instructed.

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