Get Pasientreiserno Form

The Pasientreiserno Form is essential for patients and necessary companions to claim reimbursement for required travel expenses to approved treatment facilities. This guide will provide you with step-by-step instructions on how to fill out the form online, ensuring you understand each component clearly.

Follow the steps to complete the Pasientreiserno Form online.

1. Click ‘Get Form’ button to obtain the Pasientreiserno Form and open it in the editor.
2. In the first section, fill out the patient details, including first name, last name, address, personal identification number (11 digits), postal code, city, and telephone number. Ensure that all information is accurate and clearly written in block letters.
3. If applicable, provide information for a necessary companion. This section should only be completed if there is documented need for a companion by the healthcare provider. Include their first name, last name, personal identification number (11 digits), address, postal code, city, and telephone number.
4. Detail your travel expenses to and from the treatment facility. Use one line for each mode of transportation, including dates (DD/MM/YY) and the time of treatment.
5. Fill out the payment details. Include the bank account number for reimbursement and the account holder's name. Specify the type of transport used and the distance traveled, using checkmarks for round trips if applicable. Note that no amount needs to be provided for private vehicle use.
6. If you incurred other travel expenses, provide details for parking fees, tolls, or ferry tickets. Ensure to attach receipts for these expenses.
7. Document any meals and accommodation. Indicate your departure time from your home, the duration of the trip, and attach evidence of expenses. Clearly state the number of nights for which you seek reimbursement and ensure that costs are justified.
8. Review the checklist for necessary documentation. Missing documentation may result in denial of the claim. Confirm that you have included proof of attendance from your healthcare provider, receipts for travel expenses, and any other required confirmations.
9. In the consent and signature section, affirm that all provided information is correct and consent to the patient travel office verifying necessary documentation. Include the date and your signature.
10. Once you have completed the form, review all entries for accuracy. You may then save changes, download, print, or share the form as needed.

Complete your Pasientreiserno Form online today to ensure a smooth reimbursement process.