Follow the steps to successfully complete the form

1. Click the ‘Get Form’ button to obtain the form and access it within your preferred editor.
2. Begin by entering your Alankit Card number, the insurer's name, and your policy number in the designated fields.
3. Fill in the sum assured and cumulative bonus amounts, and provide details of any previous coverage, indicating whether it is fresh or a renewal.
4. Input the name of the insured individual along with their contact information, including office, residence, and mobile numbers.
5. Indicate the relationship of the insured to the patient, such as self, spouse, or parent.
6. Complete the patient's details, including their name, age, sex, and contact information.
7. List the name of the family doctor and include their contact number.
8. If there has been a past claim, provide particulars of the claim in the specified area.
9. Fill out the hospital particulars, including the name and address of the hospital, registration number, and IPD number.
10. Provide the contact person's name at the hospital, their designation, and contact details.
11. Indicate whether the cover is individual, corporate, or group and include the employee code and relevant contact numbers.
12. Document the presenting complaints and their duration.
13. Attach relevant documents such as the doctor's prescription and details of investigations and treatments.
14. Detail past medical history relevant to current complaints, including associated illnesses and any surgeries.
15. Complete the section for maternity claims, if applicable, and provide additional relevant details for accidents.
16. Fill in the relevant positive clinical findings and investigation reports.
17. Record the date and time of hospitalization, the indication for admission, and provisional or final diagnosis.
18. State the expected duration of hospitalization and room details.
19. Outline estimated expenses, including charges for surgical procedures, consultations, and medications.
20. Ensure all fields are completely filled, avoiding slashes, as inadequate information can delay the processing.
21. Read the declaration carefully, then provide the date and place of signing along with the patient's signature.
22. Review all the entries for accuracy and completeness before finalizing the form.
23. Once completed, you can save changes, download, print, or share the filled form as needed.

Complete the Alankit Tpa Preauth Form online today to ensure timely medical authorization.