Get Awd10368g 1

Filling out the Awd10368g 1 form online is a straightforward process that ensures you provide all necessary information for your claim. This guide will walk you through each section of the form step-by-step, making it easy for you to submit your claim with confidence.

Follow the steps to successfully complete the Awd10368g 1 claim form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering your certificateholder information. This includes the employer's name, occupation, and your personal details such as your full name, certificate number, email address, social security number, and date of birth.
3. Next, provide details regarding the patient’s information. Enter the patient's name, date of birth, age, social security number, and specify your relationship to the patient.
4. Indicate whether it is the first claim or a continued claim by selecting the relevant option and listing the corresponding policy numbers.
5. Complete the injury or illness claiming section, providing the dates of treatment, accident, and if applicable, any workplace details about the injury.
6. Ensure you have the attending physician's statement, employer's statement, and any required payment statements collected for submission.
7. Review the authorization section where you must sign to allow the release of your medical information to facilitate the claim process.
8. Finalize your submission by selecting whether your address has changed and providing your current contact information.
9. After completing the form, you can save changes, download it, print it, or share the completed form as necessary.

Complete your Awd10368g 1 claim form online today for prompt processing!