Get Ericson Tpa

Filling out the Ericson Tpa form is crucial for processing insurance claims effectively. This guide provides a comprehensive and accessible overview of each section of the form to ensure users can complete it accurately.

Follow the steps to fill out the Ericson Tpa form correctly.

1. Click ‘Get Form’ button to obtain the form and access it in the online editor.
2. Begin by entering the patient details as required by the treating consultant. Fill in the name, age, sex, mobile number, residential telephone number, UHID number, and corporate name or employee code.
3. Provide details about the treating doctor, including their name, designation, and telephone number.
4. Enter the information about the hospital or nursing home where the treatment is being administered, along with the name of the family physician and their contact number.
5. Detail the presenting complaints, including the main issues that led to the patient's treatment and any relevant history related to these complaints.
6. Document the duration of presenting complaints and relevant clinical findings to provide context for the treatment needed.
7. Record any relevant past history and treatment received, alongside the requirement for investigation reports if needed.
8. Fill in the provisional or final diagnosis and proposed treatment plan. Specify diagnostic and medical management details, including the estimated date of admission and hospital charges.
9. Complete the sections for surgical management, documenting all pertinent details including charge particulars and any additional chronic disorders.
10. In case of accidents, outline the details of the occurrence and indicate whether an MLC or FIR was lodged.
11. Review the hospital declaration section and ensure it is signed and stamped by the treating doctor along with the required hospital signature.
12. Lastly, fill in the declaration of the insured. Ensure that you provide an accurate name and signature to confirm the authenticity of the information submitted.
13. Once all sections are completed, save changes, and consider downloading, printing, or sharing the form as needed.

Start completing your Ericson Tpa form online today for a smoother insurance claim process.