Get G Cms L458 1 Form

Filling out the G Cms L458 1 Form online can be a straightforward process when you know what to do. This guide aims to provide clear and supportive instructions to help you navigate through each section of the form seamlessly.

Follow the steps to complete your G Cms L458 1 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your name as it appears on your Medicare records. Ensure that the information is accurate to avoid any processing delays.
3. Next, input the date of your request in the designated field. Use the format mm/dd/yyyy for clarity.
4. In the 'Claim Number' section, provide your Medicare claim number, which you can find on your Medicare card.
5. Indicate your choice to keep Medicare Part A coverage by checking the appropriate box.
6. Fill in your mailing address, including city, state, and zip code. This will be used for any further correspondence.
7. Provide your telephone number in case additional information is required.
8. If your signature is by mark, ensure you have a witness sign in the designated area. If not, sign in the ‘SIGN HERE’ section.
9. Add the date of your signature, following the same format as previously used.
10. Lastly, review all entered information for accuracy, save your changes, and proceed to download, print, or share the form as needed.

Take a moment to complete your G Cms L458 1 Form online today!