Get C-9-a

Filling out the C-9-A form online is a straightforward process that ensures your request for additional medical documentation is clearly communicated. This guide provides step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to fill out the C-9-A form online.

1. Press the ‘Get Form’ button to obtain the C-9-A form and open it for completion.
2. Begin by filling in the provider name and fax number at the top of the form. Accurate contact details ensure clear communication.
3. Enter the date the documentation is being mailed or faxed. This provides a reference point for when the request was submitted.
4. Fill in the injured worker’s name and claim number to link the documentation request to the appropriate case.
5. Note the date the original C-9 form was received, as this will inform the timeline for the request.
6. Review the list of required medical documentation. Select the items checked as necessary for your situation. This might include reports, radiology, therapy summaries, and more.
7. Compose a brief narrative explaining the need for further passive therapy and the expected benefits. Include information about long-term treatment plans and return-to-work status.
8. Indicate the site of services, noting any relevant hospital admission details or emergency department reports.
9. Provide a narrative regarding the causal relationship between the current complaints and the injury. This helps clarify the reasons for the ongoing treatment needs.
10. Complete the section for the documentation recipient by providing the MCO name, fax number, telephone number, and address. Be sure to include city, state, and ZIP code for accurate submission.
11. Once all sections are completed, review the form for accuracy. You can then save any changes, download, print, or share the filled-out form as needed.

Complete and submit your C-9-A form online today to ensure your treatment request progresses smoothly.