Get Sterilization Form

Filling out the Sterilization Form online can be a straightforward process if you follow the correct steps. This guide provides detailed instructions tailored to help users successfully complete the form with clarity and confidence.

Follow the steps to complete the Sterilization Form online effectively.

1. Click the ‘Get Form’ button to access the Sterilization Form and open it in your preferred online editor.
2. In fields 2, 6, 13, and 20, enter the name of the procedure. Ensure that the name is consistent across all these fields and matches the name on the corresponding claim.
3. In fields 4, 7, 12, and 18, provide the patient's name. It should be consistent throughout the form and should reflect the name as documented on the BIC or the name used for determining Family PACT eligibility.
4. In fields 21 and 22, address the alternative final paragraphs. If a paragraph does not apply, mark it by crossing it out with an ‘X’. Do not remove paragraph one if the minimum waiting period of 30 days has been met; conversely, do not remove paragraph two if the minimum waiting period has not been met.
5. In field 27, ensure to include the full signature of the physician who verified consent and actually performed the operation.
6. In field 28, enter the date, ensuring it is formatted as month/day/year. This date must be on or after the sterilization date.
7. Review the completed form carefully to make sure all fields are filled out correctly and consistently, as following these instructions closely is essential to avoid delays.
8. Once the form is complete, you may save your changes, download, print, or share the document as needed.

Start completing the Sterilization Form online now to ensure a smooth process.