Get Helsana Unfall Ag

Filling out the Helsana Unfall AG form is a crucial step in managing accident-related claims. This guide provides clear instructions on how to accurately complete the form online, ensuring that you submit comprehensive information necessary for processing your claim.

Follow the steps to effectively complete the Helsana Unfall AG form.

1. Click the 'Get Form' button to access the Helsana Unfall AG form and open it in your editing tool.
2. Begin by entering your schaden-nummer (claim number) at the top of the form, if applicable. This number helps identify your claim and ensure correct processing.
3. In the section for 'Arztzeugnis UVG,' provide the necessary details of the treating physician, including their name and address.
4. Fill in the 'Verletzte/r' section with the personal details of the injured individual. This includes their name, address, birth date, AHV number, civil status, nationality/permit, and occupation.
5. Document the date of the incident in the 'Schadendatum' field using the provided fields for day, month, and year.
6. Section 1 requires details about the first treatment received, including date and time of treatment, specifying whether it occurred during office hours, outside office hours, at the accident location, or in the patient's home.
7. Provide a thorough description of the accident circumstances and related complaints in section 2.
8. For section 3, indicate the patient's general condition, including any notable perceptions, medical histories that might affect recovery, and any other factors that could impair healing.
9. In section 4, include any x-ray findings that are relevant to the patient's condition.
10. Specify the diagnosis in section 5 and remember to attach the completed HWS questionnaire if a cervical spine injury is noted.
11. Section 6 asks you to clarify the causality of the injuries. Indicate any previous similar complaints or other significant background information.
12. In section 7, outline the therapy initiated, any suggestions for further medical or non-medical measures, and whether the patient has been hospitalized.
13. Indicate in section 8 if the patient is unable to work due to injuries.
14. In section 9, specify if the patient has partially resumed work.
15. Section 10 addresses treatment completion; confirm whether this has occurred or outline future plans.
16. Section 11 requires details of any other insurances involved, such as MV, IV, Suva, or other insurers, and include relevant addresses.
17. Finally, be sure the treating physician signs and stamps the form to validate it. Ensure all information is correctly filled before submission.
18. Once completed, save changes, download your copy, print it out, or share as necessary.

Complete your Helsana Unfall AG form online today for a smooth claims process.