Follow the steps to successfully complete the form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling out Section 1, which includes client information. Provide your surname, date of birth (formatted as YYYY/MM/DD), given names, sex, street address, city, province or territory, postal code, and client ID number or band number, along with the family number.
3. If the client is under one year of age and not registered, complete Section 2 with the parent’s or legal guardian’s information, including their surname, given name, date of birth, client ID or band number, and family number.
4. In Section 3, enter the prescriber’s information. This section requires the name and title of the prescriber, their license or billing number, telephone number, fax number, and the name and title of the person who performed the hearing test.
5. Fill out Section 4 with the client's health information. Indicate the diagnosis, reason for the request, and the date of the most recent audiometric test (a copy of which is required for new or replacement hearing aids). Indicate whether the client has applied for a hearing aid with WCB, and provide details if applicable, covering any questions concerning injury or noise exposure.
6. Section 5 pertains to initial benefit requests, replacements, and repairs. Ensure that you include the benefit code, description of the benefit, and ear details (left or right) in this section along with any required audiometric test information.
7. Complete Section 6 with the provider's information. Record the name and title of the provider, their telephone number, unit cost, manufacturer name, model number or size, date of fitting (if it's a repair), serial number, and provider number. Include a fax number if necessary.
8. Section 7 requires confirmation of the hearing aid and hearing aid repair. After obtaining prior approval and fitting the client with the hearing aid, fill in the prior approval number, date of service, and provide the provider's signature and date. Ensure to fax this form along with a copy of the manufacturer's invoice to the appropriate Health Canada regional office.
9. Review the entire form for accuracy and completeness. Make any necessary edits before saving your changes, and then download, print, or share the form as needed.

Begin filling out the Nihb Hearing Aid Prior Approval Form online today to ensure your hearing needs are met.