Get Form 2c Manulife

Filling out the Form 2c Manulife online is a straightforward process that requires careful attention to detail. This guide provides step-by-step instructions to ensure you complete the form accurately.

Follow the steps to successfully complete the Form 2c Manulife.

1. Click ‘Get Form’ button to access and open the form in an online editor.
2. Start by entering the name of the patient in the designated field. Make sure it matches the identification documents.
3. Fill in the patient's place and date of birth as well as their age. This information is crucial for identification and reference.
4. Indicate the patient's gender by selecting the appropriate option for Male or Female.
5. Record the date of hospitalization, ensuring it accurately reflects the patient’s admission date.
6. Provide a brief history of the disease in the section labeled 'Anamnesa; Riwayat Penyakit'.
7. Enter the date when the symptoms or complaints first occurred. Use the format dd mm yyyy.
8. Indicate the date of the first consultation using the same date format.
9. Include the name and address of the referring doctor for proper documentation.
10. Summarize the results of physical examinations, lab tests, X-rays, and any other relevant medical evaluations.
11. Provide the diagnosis or suspected diagnosis in the appropriate section.
12. Document the date when the patient was informed about their diagnosis.
13. Describe the underlying disease or condition that prompted the diagnosis.
14. Fill in the date when the underlying disease was first identified.
15. Detail any therapy or treatment that has been administered to the patient.
16. Indicate if the diagnosis is related to any mental disorders, congenital anomalies, pregnancy, or accidents by selecting 'Yes' or 'No'.
17. If applicable, answer the follow-up questions regarding permanent deformities or dysfunction caused by the diagnosis.
18. If the patient has previous consultations or hospitalizations, provide the relevant details and dates.
19. Conclude by having the treating doctor certify the information by filling in their name, hospital name, address, and signing the document.
20. Finally, save your changes to the form. You can download, print, or share the filled-out form as needed.

Get started on completing your Form 2c Manulife online today.