Get Anexa 39 D 2020-2025

Filling out the Anexa 39 D form online is a straightforward process that helps users submit medical recommendations for devices intended for recovery from specific deficiencies. This guide will provide you with clear, step-by-step instructions to ensure a smooth completion of the form.

Follow the steps to complete the Anexa 39 D form online.

1. Press the ‘Get Form’ button to access the Anexa 39 D document and open it for editing.
2. Begin by entering the registration number on the form. This number will help track the medical recommendation.
3. Fill in the detailed unit information, including the address and whether it is for a Medical Facility, Outpatient Clinic, or Hospital.
4. Indicate the member state as ROMANIA and provide the CUI (Unique Identification Code) along with the contract number associated with the Health Insurance House.
5. Enter the details of the prescription, including the name of the prescribing physician, their specialty, and contact information.
6. For the patient, fill out the full name, contact address, personal identification number, and the diagnosis.
7. Check the appropriate boxes to indicate whether the deficiency is a result of a professional illness or an accident.
8. List the type and quantity of medical devices recommended, selecting from the options provided in the annex.
9. Ensure the document is validated by the signature or electronic signature of the issuing physician, along with their stamp.
10. Once all sections are completed, save your changes, and choose to download, print, or share the form as needed.

Start filling out your Anexa 39 D form online today!