Get Fracture Please Send Us A Copy Of The Radiology Reading Along With This Form,

Filling out the Fracture Please Send Us A Copy Of The Radiology Reading Along With This Form is an important step in processing your claim. This guide provides clear instructions to help you complete the form accurately and efficiently, ensuring all necessary information is included.

Follow the steps to correctly complete the form online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. In Section A, provide the name and address of the contract holder. Ensure that you enter the postal code and contract number accurately.
3. If applicable, indicate whether the benefits for this claim are covered by another insurance plan by selecting 'Yes' or 'No' and providing the company name and contract number if relevant.
4. In Section B, complete the claimant’s statement. Input the name, date of birth, and relevant details regarding the date and place of the accident. Specify the nature of injuries and describe the circumstances of the injury as needed.
5. Continue in Section C by completing the physician’s report. Here, the physician should provide a diagnosis, dates of visits, and hospitalization details.
6. Section D requires an authorization to collect and communicate personal information. Ensure that the contract holder and the injured person (if applicable) sign and date this section.
7. After filling out all sections, review your entries for accuracy. Save the changes, and select the option to download or print the completed form. You may also share it as needed.

Complete your Fracture claim form online today to ensure prompt processing of your request.