Get Certificate Of Treatment

This guide provides a clear and comprehensive overview of how to complete the Certificate Of Treatment online. Whether you are filling out the form for the first time or need a refresher, these instructions will walk you through each section with ease.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin filling out the 'Policy / Certificate No' field with the appropriate number as provided in your policy documents.
3. In the authorization section, ensure you complete the signed declaration, granting permission to share medical information related to the claimant's injury or illness.
4. Enter the 'Employer’s Signature/Company’s Stamp/Date' to verify the employer’s involvement and acknowledgment.
5. Complete the 'Claimant’s/Employee’s Signature/Date' section to confirm the claim's details.
6. Fill in the 'Name of Patient' and 'Name of Employee / Member’s Company' sections with the relevant names.
7. Document the 'Name of Medical Establishment' where treatment occurred.
8. Select the 'Nature of Admission' by checking the box for out-patient, in-patient, or day surgery.
9. Detail the 'Period of Admission' by writing the start and end dates of treatment.
10. Describe the 'Nature and Extent of Injury' comprehensively, providing all necessary details.
11. Respond to the questions related to the cause of the injury, including whether it was solely due to the accident.
12. Indicate if the claimant was sober at the time of the accident and if prior medical history contributed to the injury.
13. Specify the duration the claimant has been unable to perform their usual duties due to the accident.
14. Outline any permanent disability sustained, including the nature and percentage.
15. Provide information about any existing physical defects at the time of the accident.
16. Describe the surgical procedures or treatments administered, including the dates of these procedures.
17. Complete the section concerning whether the procedure was cosmetic or medically necessary.
18. Confirm if the patient is still under medical care, providing necessary details if applicable.
19. Finally, have the doctor or surgeon sign the form, and include their name, title, and address of the clinic or hospital.
20. Review all fields for accuracy, then save your changes, and you can download, print, or share the completed form as needed.

Complete your document online today and ensure a smooth filing process.