Follow the steps to successfully complete your application form.

1. Press the ‘Get Form’ button to access the application form and open it in the appropriate editing tool.
2. Begin with Section 1: Main member details. Fill in your surname, title, member number, initials, plan, physical address, and postal code.
3. Proceed to Section 2: Patient details. Enter the patient’s surname, dependant code, first name, date of birth (in D D M M Y format), title, telephone number, fax number, cell number, email address, preferred postal address, and postal code.
4. In Section 3: Patient consent, read the statements carefully. The member or guardian must confirm accuracy of information, acknowledge responsibilities, and give consent. This section must be signed and dated.
5. Move on to Section 4: General patient information to be completed by the attending doctor. This includes gender, date of HIV diagnosis, test used, counselling details, significant past medical history, and additional patient specifics.
6. Fill in details regarding previous CD4 & viral load studies in Section 5, including dates, results, treatment, and compliance with antiretroviral therapy.
7. Input information required in Section 6: Doctor’s details, covering surname, initials, practice number, specialty, physical address, postal code, and contact numbers.
8. Section 7: Doctor's consent requires the doctor to confirm the accuracy of the clinical details. This section must also be signed and dated.
9. Finally, in Section 8, ensure that all necessary attachments are included with your application, such as confirmation of HIV status and relevant medical test results.
10. After completing the form, you can save your changes, download the form, print it, or share it as needed. Ensure that you submit your application to the designated fax or postal address.

Begin filing your documents online today to ensure a smooth application process.