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How to use or fill out OMB NO 0938-0008 with our platform
- Click ‘Get Form’ to open OMB NO 0938-0008 in the editor.
- In Block 1, print your name as it appears on your Health Insurance Card (Last Name, First Name, Middle Name).
- For Block 2, enter your Health Insurance Claim Number exactly as shown on your Medicare card and check the appropriate box for the patient’s sex.
- In Block 3, provide your mailing address and telephone number. If this is a new address, check the corresponding box.
- Describe the condition related to treatment in Block 4. Check 'Yes' or 'No' for employment-related questions in Blocks 4b and 4c.
- Complete Block 5 if you have additional medical coverage. Provide details such as policy numbers and insurance names.
- Sign and date the form in Block 6. If unable to sign, follow instructions for a witness signature.
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