Adnic claim form 2026

1. Click ‘Get Form’ to open the adnic claim form in the editor.
2. Begin by filling in the Patient Details section. Use capital letters for clarity. Include the patient's name, health card number, date of birth, group member's name, employer's name, telephone number, email ID, and address.
3. In the Reason for Not Using Listed Healthcare Facilities section, select one option that best describes your situation. If 'Other', please specify.
4. The Medical Information section must be completed by the treating doctor. Ensure they provide details about the condition requiring treatment, visit date, onset and duration of illness, and treatment details.
5. Fill in Hospital/Clinic Details with the name and address of the facility where treatment was received. Include bill number, treatment date, currency (if applicable), description of services provided, and total amount.
6. Complete Bank Details with account holder name, account number/IBAN, bank name and address, currency used for payment, and SWIFT code if necessary.
7. Answer questions in Other Information regarding work-related cases or if another insurance covers the claim.
8. Finally, sign and date the Declaration section to confirm that all information is accurate and complete before submission.

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