Get Medical Statement Request Application - Saskatchewan

This guide provides a comprehensive overview of the process for completing the Medical Statement Request Application for Saskatchewan. It is designed to help you navigate each section of the form with clarity and confidence.

Follow the steps to successfully complete your application online.

1. Click ‘Get Form’ button to access the Medical Statement Request Application form and open it in your preferred online document editor.
2. Begin by filling out the applicant information section. Include the family name, given name, and date of birth in the specified format (DD-MM-YYYY). Enter your address details, including the apartment number, street number, city or town, province/state, postal code (if applicable), and country.
3. Provide the health services number, which is a nine-digit number, and a ten-digit contact phone number where you can be reached.
4. Select the type of statement you require by checking either the physician statement or the hospital statement option.
5. Complete Section 1 regarding your relationship to the applicant. Choose option A for children under 18 years of age (noting that parental signature is required) or option B for other relationships, and specify the relationship in the provided space.
6. Indicate whether a power of attorney or executor is signing on behalf of the applicant. If yes, ensure to attach the necessary documents like the POA, Will, or Letter of Administration.
7. If applicable, fill out Section 2 to authorize the release of medical records. Include the name of the third party and their relationship to the applicant.
8. In Section 3, provide the time frame for the requested information (e.g., from January 1, 2014, to December 31, 2014).
9. Finally, sign the application in Section 4. Ensure to include the date. Circle your role as either applicant, guardian, trustee, power of attorney, executor, or witness. Note that a witness is necessary if the applicant signs with an 'X' or a mark.
10. Review the completed application for accuracy, then save any changes. You can download, print, or share the form as needed.

Complete your Medical Statement Request Application online today for efficient processing.