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How to fill out the Thebemed online
Thebemed is an essential application form for chronic medicine management. This guide will provide you with clear, step-by-step instructions to successfully complete the form online.
Follow the steps to fill out the Thebemed form correctly.
- Click ‘Get Form’ button to access the form and open it for editing.
- Begin by filling out the member details section. Include your membership number, surname, title, initials, and email address.
- Next, provide the patient details. Enter the patient's name and surname, title, identification number or date of birth, address, email address, and telephone numbers (home, work, and cell).
- Authorize your medical practitioner by checking the box that allows them to disclose any necessary information to Polmed. Ensure that your medical practitioner is fully informed about the medication requirements.
- For the medical practitioner details, enter their surname, initials, practice number, specialty, telephone, fax, cellphone, and postal address.
- Provide specifications about the associated specialist if relevant, including their name and practice number.
- Complete the clinical examination section. Mark the gender, input weight and height, blood pressure, smoking status, and exercise frequency. Also, list any known allergies.
- Fill out the chronic conditions mandatory for the application. Indicate any chronic illnesses that apply by placing an 'X' next to the listed conditions.
- In the medication prescribed section, include the ICD-10 codes, detailed diagnosis, medication names (trade or generic), strength, directions for use, and dates associated with each medication.
- Complete the prescribed minimum benefits section by affirming the accuracy of the information and providing the necessary signatures from both the member and the prescribing doctor.
- Once all information is provided, review the form for accuracy. You can then save your changes, download, print, or share the form as needed.
Begin your application for chronic medicine management by filling out the Thebemed form online today.
Thebemed is owned by a team of healthcare professionals and entrepreneurs who are passionate about improving access to medical services. Their collective experience and expertise drive the company's mission to provide affordable and quality healthcare options. By prioritizing customer satisfaction, Thebemed aims to serve your health needs effectively.
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