Get Generic Medical Claim Form - Justice For Janitors - Justiceforjanitors

Filling out the Generic Medical Claim Form for Justice For Janitors can be a straightforward process if you follow the right steps. This guide will provide clear instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete your medical claim form online.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Begin by entering the member's personal information. Fill in their first name, middle name (if applicable), and last name. Then, provide the member's full address, including the number, street, apartment number (if applicable), city, province, postal code, and their date of birth in the format dd/mm/yyyy.
3. Indicate the member's sex by selecting either 'Male' or 'Female.' Input the member’s social insurance number and specify whether this is an initial claim or a subsequent claim.
4. If the claim is for a dependent child, enter the dependent's name and date of birth (dd/mm/yyyy). You should also provide the spouse’s date of birth if applicable.
5. Detail the expenses incurred by entering the date the expense was incurred in the format day/month/year. Next, provide the name or D.I.N. of the drug supplier or pharmacy, and specify the type of expense.
6. List the amount charged for the expenses covered in this claim. Ensure you label the charges as belonging to you, your spouse, or your dependent child.
7. Answer the question regarding any other coverage that may pay a benefit for this claim by selecting 'Yes' or 'No.'
8. Review the authorization section regarding the exchange of personal information for processing this claim. Ensure you understand and agree to the terms before signing.
9. Sign and date the form where indicated, ensuring to include your telephone number with the area code for any follow-up communication.
10. After filling out the form completely, save your changes. You may now download, print, or share the completed form as needed.

Complete your medical claim form online today to ensure timely processing of your claim.