Green shield claim form for medical devices 2026

1. Click ‘Get Form’ to open the green shield claim form for medical devices in our editor.
2. Begin by filling in the PROVIDER section. Enter your Green Shield Provider Number, Provider Name, and contact details including phone number.
3. Next, complete the PATIENT section. Input the patient's Green Shield ID number, surname, first name, birth date, and address information.
4. In the MEDICAL DEVICES PROVIDED section, list each device along with the corresponding charges. Ensure you include any necessary tax information.
5. Indicate if there is any other group insurance coverage that may apply by selecting 'YES' or 'NO' and providing additional details if applicable.
6. Review all sections for accuracy. Sign the form as both provider and patient where indicated to certify that all information is correct.
7. Finally, attach all required documents such as original receipts and prescriptions before submitting your claim.

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