Get Gender Reassignment Surgery Gender Reassignment Surgery

This guide provides a professional and supportive overview of the process needed to fill out the Gender Reassignment Surgery Gender Reassignment Surgery form online. Users are encouraged to follow the detailed steps to ensure accurate and efficient submission of their precertification request.

Follow the steps to complete the form efficiently.

1. Press the ‘Get Form’ button to access the Gender Reassignment Surgery Gender Reassignment Surgery form and open it in your document editor.
2. In Section 1, provide the general information required, including the member’s name, administrative reference number, member ID, and date of birth. Ensure that the patient is at least 18 years of age.
3. Also in Section 1, enter the requesting provider or facility's name and contact details, including phone and fax numbers. If applicable, include the name of any assistant or co-surgeon, along with their Tax Identification Number (TIN).
4. Move to Section 2 and specify whether the treatment is new or continued. Answer the questions regarding the patient’s gender dysphoria, consent capability, and any significant health concerns clearly and accurately.
5. Continue filling out Section 2, indicating if the request is for female-to-male or male-to-female services. Each choice will guide you to the appropriate subsequent sections.
6. Section 3 is for requests for female-to-male services. Select the requested services and answer questions about hormone therapy and living in a gender role congruent to the patient’s gender identity.
7. If completing Section 5 for male-to-female services, select the requested services and provide the necessary details about referral letters and hormone therapy.
8. In Section 6, gather and prepare all required documentation, such as the current history and physical, office notes, mental health referral letters, and documentation of hormone therapy.
9. Review all sections for completeness. In Section 8, fill in the details for the person completing the form, including their title, if applicable.
10. Once the form is complete, submit it along with the requested medical documentation to the Precertification Department via confidential fax or through electronic submission.

Take the next step in your health journey by completing the necessary documents online.