Get Accident Information Form - Uhahealthcom

Completing the Accident Information Form online is an essential step in documenting your incident accurately. This guide will provide you with a straightforward approach to filling out each section of the form, helping you ensure all necessary information is captured effectively.

Follow the steps to complete the form easily and accurately.

1. Press the ‘Get Form’ button to access the Accident Information Form, which will open it for editing and filling.
2. Begin by entering your full name in the 'Member Name' field and your UHA Member ID in the designated area, following the format provided.
3. Provide the date of injury in the specified format and enter the full address where the accident occurred.
4. In the 'Brief description' section, outline the cause of the accident and detail the injuries or illnesses suffered. If you need more space, feel free to attach additional pages.
5. Indicate whether the occurrence involved a motor vehicle by selecting 'Yes' or 'No.' If 'Yes,' complete the subsequent fields regarding the vehicle ownership and insurance details.
6. If the occurrence was employment-related, specify that by selecting 'Yes' or 'No,' and complete the relevant questions regarding Workers’ Compensation claims.
7. If the accident occurred on someone else's property, fill in the property owner's name and address, and respond to questions about their insurance.
8. If you have hired legal counsel, provide the contact details for your lawyer in the corresponding section.
9. Review all entries for accuracy, then sign the form to affirm that the information provided is truthful and complete.
10. Once completed, you may save your changes, download, print, or share the form as needed.

Complete your Accident Information Form online today to ensure all your details are accurately recorded.