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How to use or fill out does the specialist have to sign the d1216s dva form
- Click ‘Get Form’ to open it in the editor.
- Complete the Patient Details section by entering the patient's file number, first name, initial, and surname. If unknown, include their date of birth and address.
- In the 'Item Number or Description of Service' field, write down the relevant service provided.
- Fill out the 'Condition Treated' section only if applicable for White card holders or emergency services.
- Specify the 'Treatment Location' if services were not conducted in rooms; include hospital details if necessary.
- Ensure that the patient provides their signature. If they cannot sign, complete the appropriate section yourself.
- For emergency services, make sure to cross and sign in the designated area.
- Submit all copies as required: Departmental copy with your claim, provide a Patient copy to them, and retain a Claimant copy for your records.
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