Get Hosmed Chronic Application Form 2020

The Hosmed Chronic Application Form 2020 is essential for patients seeking medical benefits for chronic conditions. This guide provides a clear and structured approach to completing the form online, ensuring that you provide all necessary details accurately.

Follow the steps to fill out the Hosmed Chronic Application Form 2020 online.

1. Click ‘Get Form’ button to access the application and open it in your preferred editor.
2. Complete Section A by providing your member details, including member number, name, contact information, and postal address. Ensure all information is accurate and printed clearly.
3. In Section B, input the patient details, including the dependent code, name, contact information, and postal address of the patient if different. Please indicate the gender and date of birth.
4. Fill out Section C by providing your doctor's details, including their initials, surname, practice number, contact information, and specialty.
5. In Section D, your attending medical practitioner will need to complete the clinical entry criteria for the PMB-CDL conditions. Ensure they provide their signature on each page to validate the conditions.
6. Section E requires the principal member to make a declaration about the accuracy of the information provided. The principal member must sign and date this section.
7. Proceed to complete Section F, providing specific details regarding the chronic conditions being claimed, including ICD-10 codes and clinical entry criteria for each relevant condition.
8. If applicable, Section G covers additional PMB conditions for autoimmune diseases and other relevant medical details. Ensure proper signatures are collected here as well.
9. Once all sections are filled out and verified, you can save your changes, download the form, print it for physical submission, or share it as needed.

Begin filling out your Hosmed Chronic Application Form 2020 online today for a smoother claims process.