Get Third Party Request For Personal Claims History Information 2020-2025

This guide provides a straightforward approach to completing the Third Party Request For Personal Claims History Information. By following the outlined steps, users can ensure that their requests are processed efficiently and accurately.

Follow the steps to complete your request successfully.

1. Press the ‘Get Form’ button to access the document and open it in an online form editor.
2. In Section 1, enter the personal claims history (PCH) information. Begin by providing your last name, first name, and health number as they appear on your health card. Include the version code and your mailing address, ensuring accuracy in the unit number, street number, street name, city/town, province, and postal code.
3. Next, in the same section, indicate your date of birth following the format yyyy/mm/dd. If applicable, add a second name as it appears on your health card. This is particularly important for accurate identification.
4. Specify the time period for the PCH information you are requesting. Enter the start and end dates, ensuring they do not exceed the past seven years.
5. Indicate if this request supports residency for Citizenship and Immigration by selecting 'Yes' or 'No.' This step is important for the processing of your request.
6. Move to Section 2, where you must provide your signature or that of a substitute decision maker (SDM). Select the appropriate description of your relationship to the requester. Fill in your last name, first name, email address, and the date using the format yyyy/mm/dd. Finally, sign the document to validate your request.
7. After thoroughly reviewing the completed form for accuracy, you can save your changes, download, print, or share the form as needed.

Complete your document requests online today to ensure timely processing.