Get Travel/appointment Verification Information - Texas Attorney General - Oag State Tx

This guide provides a clear and concise overview for users on how to successfully complete the Travel/appointment Verification Information form for the Texas Attorney General. Whether you are seeking reimbursement for travel expenses or lost wages related to appointments, this step-by-step approach will assist you in filling out the form accurately and effectively.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and access it in the online editor.
2. Begin by entering your name in the 'Victim/Claimant' section and your Social Security Number to identify your claim.
3. Indicate what you are claiming by checking all applicable boxes (travel, lost wages, or lost wages for bereavement).
4. Provide the date(s) of the appointment and the patient's name who attended the appointment.
5. Fill in the complete start address, ensuring it includes the street number, street name, city, state, and zip code. Remember, the travel distance must exceed 20 miles one way.
6. Indicate the complete destination address, including the name of the facility and its address details.
7. Specify the type of appointment by providing the diagnosis code or criminal case number, and the purpose of the appointment or travel.
8. Collect the signature and printed name, along with the phone number of the verifying provider or official, to confirm your appointment.
9. If your travel exceeds 60 miles, note that you may be eligible for lodging and food reimbursement. Ensure you have the required receipts for lodging and remember that food reimbursement does not require receipts.
10. For lost wages claims, provide your employer's information including name, phone number, and address so they can be contacted to verify details.
11. Sign and date the form at the bottom to complete your submission.
12. Save changes to your form, then download, print, or share it as necessary based on your needs.

Start completing the Travel/appointment Verification Information form online today to ensure your expenses can be reimbursed.