Get 3shealth Dip Continuance Application Form May 2012.doc

Filling out the 3sHealth DIP Continuance Application Form online can be a straightforward process if you follow the provided steps carefully. This guide aims to assist you in completing the form accurately, ensuring you provide all necessary information to facilitate your application.

Follow the steps to successfully complete the application form.

1. Click ‘Get Form’ button to acquire the form and open it in the editor.
2. Begin with Part 1, which includes employee information. Fill in your full name, social insurance number, health region, and date of birth. Indicate if your address has changed, and if so, provide your new address.
3. Provide a detailed description of your current daily activities, as well as any changes in your medical conditions since your last report.
4. List all physicians and medical practitioners currently involved in your treatment, including appointment dates since your last update.
5. State whether you have participated in any gainful employment during your absence. If yes, provide a description.
6. Indicate if you have received any income during your absence from work by checking the appropriate boxes for various income sources. If applicable, attach copies of correspondence showing the type and amount of income received.
7. Estimate when you expect to return to your regular occupation and indicate if you are willing to participate in a return to work program.
8. Review the certification statement, ensuring the information provided is accurate. After confirming, write your signature and date the form.
9. Once you have filled out Part 1, remember that your physician needs to complete Part 2 of the form.
10. After all sections are completed, save your changes, and you can choose to download, print, or share the completed form.

Complete your applications online today to ensure timely processing of your benefits.