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Opmed chronic forms 2026

The document is an application form for the OPMED Chronic Disease List (CDL) and other chronic conditions, requiring completion by attending medical practitioners. It outlines necessary patient and doctor information, clinical entry criteria for various chronic diseases, and the importance of signatures for validation. The form emphasizes that incomplete applications may lead to non-registration of conditions and includes a declaration regarding the accuracy of provided information.

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Click ‘Get Form’ to open the opmed chronic form in the editor.
Begin by entering the patient information, including the Principal Member Number and Dependant Code. Ensure accuracy as this is crucial for processing.
Fill in the Doctor Information section with your details, including initials, surname, practice number, specialty, email address, and contact numbers.
For each chronic condition listed, mark the relevant disease and provide the corresponding ICD-10 code. Include any clinical entry criteria or remarks as required.
Complete the declaration section by signing and dating it. This confirms that all information provided is accurate and complete.
Review all sections for completeness before submitting. You can easily save or share the completed form directly from our platform.

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