Get Form 51w6, Worksafebc. Hearing Aid Replacement Information

Filling out the Form 51W6 is an essential step for individuals seeking assistance with hearing aid replacements through WorkSafeBC. This guide will provide clear instructions to help users navigate the online completion of the form easily and effectively.

Follow the steps to successfully complete your hearing aid replacement request.

1. Press the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Begin by entering the client information, which includes the worker's last name, first name, and middle initial.
3. Fill in the street address, city, postal code, and phone number, ensuring that you include the area code.
4. Indicate whether the worker is retired by selecting 'Yes' or 'No'. If yes, provide the retirement date in the format (yyyy-mm-dd).
5. Input the WorkSafeBC claim number as prompted.
6. Proceed to the clinic information section, entering the clinic name, payee number, and the date (yyyy-mm-dd).
7. Provide the clinic’s postal code, phone number (including area code), and mailing address.
8. Specify the practitioner providing the service along with their fax number (including area code).
9. In the description of current hearing aid(s) section, indicate whether the present hearing aid is less than five years old by selecting 'Yes' or 'No'.
10. If the answer is 'No', a form 51W12 must accompany this request for payment. If 'Yes', obtain authorization from the WorkSafeBC Hearing Loss Claims Department before dispensing new devices.
11. List the style of hearing aid (e.g., BTE, RIC, ITE), serial number, and the date it was fitted (yyyy-mm-dd).
12. Detail the repair history for the hearing aids.
13. Select the reasons for replacing the hearing aids by checking the appropriate boxes and providing additional explanation if necessary.
14. Document any troubleshooting steps taken to resolve issues, listing them as needed.
15. Outline the proposed solution, which may include the style, make, and model of the new hearing aids.
16. Confirm that the following mandatory submissions are included: the form 83D110 Hearing Aid Program Cover Sheet, current audiogram, and current real ear measurements.
17. Finally, review all entries for accuracy before saving changes, downloading, printing, or sharing the completed form.

Complete your Form 51W6 online today to ensure timely processing of your hearing aid replacement request.