Scptac org forms 2025

1. Click ‘Get Form’ to open the scptac org Claim Form in the editor.
2. Begin with Part I: Participant & Spouse Information. Fill in the required fields for both the participant and spouse, including names, Social Security Numbers (last four digits), dates of birth, addresses, and phone numbers.
3. Proceed to Part II: Patient Information. Enter the patient's name, address (if different), relationship to the participant, gender, and marital status. If applicable, indicate if the dependent is a full-time student.
4. In Part III: Other Coverage or Benefits, specify if the patient has other coverage. If yes, provide details about the policy holder and insurance information.
5. Move to Part IV: Claim Information. Indicate whether this claim is for a new injury or illness and provide a detailed description of how it occurred, including location and time.
6. Finally, complete Part V: Authorization by signing and dating where indicated. Ensure all sections are filled out accurately to avoid delays in processing your claim.

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