CHIS F01 - Claim for reimbursement of medical expenses 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your details as the Main Member. Enter your surname, first name(s), and CHIS ID in the designated fields.
3. If the patient is not the Main Member, provide their surname, first name(s), and CHIS ID. Include their home address if different from yours.
4. Indicate if other insurance covers the medical expenses related to the accident. If yes, provide the insurance name and policy number.
5. Fill in the date and time of the accident, along with a detailed description of where it occurred and its circumstances.
6. Specify how you were transported to treatment and provide details about the care provider.
7. Complete sections regarding any third parties involved, including witnesses, if applicable.
8. Finally, review all information for accuracy before signing and dating the form at the bottom.

Start using our platform today to easily complete your CHIS F01 form for free!