Get Injectable Vitamin B12 Form - Government Of Nova Scotia

Filling out the Injectable Vitamin B12 Form online can help ensure that you receive the necessary coverage for your vitamin B12 therapy. This guide will provide clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the document and open it in the appropriate editor.
2. Begin by entering the patient's surname in the designated field.
3. Next, input the patient's given name in the corresponding section.
4. Provide the patient's health card number, which is essential for processing the request.
5. Enter the patient's date of birth in the specified format to verify identity.
6. Complete the patient's address information, ensuring all details are current and accurate.
7. Indicate the initiation of Vitamin B12 therapy for the patient by selecting one of the provided options. If applicable, include the laboratory-confirmed subnormal Vitamin B12 levels.
8. Specify the reason the intramuscular (IM) route is necessary by selecting from the options given. Include any additional explanations as necessary.
9. Use the additional comments section to include any relevant notes that provide further context to the request.
10. Enter the physician's name and address in the required fields to validate the request.
11. Complete the CPSNS number field with the physician's registration number.
12. The physician must sign the form and enter the current date to authorize the request.
13. After filling out all sections, save your changes. You can then download, print, or share the form as necessary.

Complete your Injectable Vitamin B12 Form online today to secure your coverage.