Get Opmed Chronic Forms

Filling out the Opmed Chronic Forms online is a straightforward process that ensures all necessary information is captured for chronic disease management. This guide will provide step-by-step instructions to help you complete the forms accurately.

Follow the steps to successfully fill out the form.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the date at the top of the form. Ensure that you include the patient information, including the principal member number as per the card and the dependant code.
3. In the doctor information section, fill in the doctor’s initials and surname, practice number, specialty, e-mail address, and contact numbers including rooms, fax, and cell.
4. For the clinical entry criteria, the treating physician should provide the relevant details for each chronic disease condition by marking the appropriate boxes and including the applicable ICD-10 codes.
5. Ensure that any required clinical documentation, such as test results or medical reports, is attached to support the patient's condition and treatment.
6. At the bottom of each page, the physician must sign to confirm the CDL condition, including the necessary ICD-10 codes. This signature is crucial for the validity of the application.
7. Complete the declaration section by having the principal member print and sign their name, alongside the location and date of signing.
8. Once you have filled out all sections of the form, you can save your changes, download, and print the form for submission. If needed, share the completed form with your healthcare provider via email or fax.

Start filling out the Opmed Chronic Forms online today to ensure proper management of chronic conditions.