Loading
Form preview picture

Get Discovery Oncology Pmb Application Form 2020

Oncology PMB application form Request for additional cover from the Prescribed Minimum Benefits Contact us Tel 0860 99 88 77 PO Box 784262 Sandton 2146 www. discovery. co. za Patient s name and surname Membership number How to complete this application form What you must do Please go through these two steps Step 1 Fill in the form Step 2 Sign the application form. 1. To avoid administrative delays please ensure this application is completed in full. 2. Please complete this form if you wish to apply for additional cover for the diagnosis of medicine for or out-of-hospital management of a Prescribed Minimum Benefit PMB condition. 3. You the member must complete Section 1 of this form. 4. Your doctor must complete Section 2 and Section 3 and include detailed documents supporting your application. 5. Please fax this completed and signed form with any supporting documents to 011 539 5417 or post it to Discovery Health Oncology PO Box 784262 Sandton 2146. Oncology PMB application form Request for additional cover from the Prescribed Minimum Benefits Contact us Tel 0860 99 88 77 PO Box 784262 Sandton 2146 www. discovery. co. za Patient s name and surname Membership number How to complete this application form What you must do Please go through these two steps Step 1 Fill in the form Step 2 Sign the application form* 1. To avoid administrative delays please ensure this application is completed in full* 2. Please complete this form if you wish to apply for additional cover for the diagnosis of medicine for or out-of-hospital management of a Prescribed Minimum Benefit PMB condition* 3. You the member must complete Section 1 of this form* 4. Your doctor must complete Section 2 and Section 3 and include detailed documents supporting your application* 5. Please fax this completed and signed form with any supporting documents to 011 539 5417 or post it to Discovery Health Oncology PO Box 784262 Sandton 2146. You can also contact our oncology call centre on 0860 99 88 77 if you have any questions. 6. You will receive a letter informing you of our decision and the process to follow for approved requests. 7. You may call us if you would like to lodge a formal dispute to a declined appeals decision* 1. About yourself main applicant Title Initials Surname ID number Date of birth Y M D Postal address Code Telephone H W Cellphone Fax Email address Name of patient or dependant May we communicate your information to you by email F or fax F Has your treatment been approved on the Oncology Benefit Yes F No F 109759 11/12 If yes your doctor must list the condition for which your treatment has been approved on the next page. Page 1 of 2 Discovery Health Medical Scheme. Registration number 1125 2. Information about treatment request doctor to complete 2. 1 Application for medical management In-hospital F Out-of-hospital F Consultation or procedure code Condition Number of consultations or procedures each year Description Medicine name strength and dosage NAPPI code Frequency Quantity 3.

How It Works

TEL rating
4.8Satisfied
36 votes

Tips on how to fill out, edit and sign Declined online

How to fill out and sign Quantity online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Are you still seeking a fast and practical tool to complete Discovery Oncology Pmb Application Form 2020 at a reasonable cost? Our platform provides you with an extensive variety of forms available for filling out on the internet. It only takes a few minutes.

Keep to these simple actions to get Discovery Oncology Pmb Application Form 2020 ready for sending:

  1. Select the document you require in the library of legal templates.
  2. Open the form in our online editor.
  3. Look through the recommendations to find out which info you will need to include.
  4. Click on the fillable fields and add the necessary details.
  5. Put the relevant date and insert your electronic autograph as soon as you fill out all other fields.
  6. Look at the completed document for misprints as well as other errors. In case you need to correct some information, the online editing tool along with its wide variety of instruments are ready for your use.
  7. Download the resulting form to your device by clicking on Done.
  8. Send the e-form to the parties involved.

Filling in Discovery Oncology Pmb Application Form 2020 doesn?t have to be perplexing anymore. From now on simply cope with it from your apartment or at the workplace from your mobile device or personal computer.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Consultation FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to Discovery Oncology Pmb Application Form 2020

  • Oncology
  • Applicant
  • TEL
  • Speciality
  • surname
  • informing
  • consultation
  • pathology
  • declined
  • administrative
  • delays
  • quantity
  • Postal
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.