Get Have The Treating Physician Complete Section B Physician''s Statement And Sign The Claim Form Or

Filling out the Have The Treating Physician Complete Section B Physician's Statement And Sign The Claim Form Or is crucial for ensuring that your accidental injury claim is processed efficiently. This guide will walk you through each step of the form, providing detailed and user-friendly instructions to help you complete it online.

Follow the steps to complete your form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the Policyholder/Patient Information section. Fill in the policy number, first name, last name, mailing address, city, state, and ZIP code. Sign the claim form to validate your submission.
3. In the Patient Information section, provide the patient's phone number and social security number. Confirm their relationship to the primary policyholder by selecting the appropriate option.
4. Indicate the patient’s sex and birth date, and check if the dependent child is a full-time student, providing the necessary school information if applicable.
5. Answer all the questions regarding the accident, including the date, a description of how it happened, and the location of the accident. Specify if the patient was the driver in a motor vehicle accident and attach any required police report.
6. If applicable, include hotel receipts for lodging while the patient was hospitalized and confirm if necessary by checking the policy.
7. Have the treating physician fill out Section B: Physician's Statement. This section includes the physician's name, address, service dates, diagnosis codes, procedure codes, and detailed information about the incident and hospitalization.
8. Ensure that the physician signs and dates Section B, noting their tax ID number below their signature.
9. After completing the form, save any changes made. You can then download, print, or share the form as required.

Complete your forms online to ensure timely processing of your claims.