Get Animas Canada

Filling out the Animas Canada form can be a straightforward process with the right guidance. This guide will walk you through each section of the Certificate of Medical Necessity, ensuring you have all the information needed to complete the form accurately.

Follow the steps to fill out the Animas Canada form online.

1. Click the ‘Get Form’ button to access the Certificate of Medical Necessity, enabling you to begin filling it out.
2. Provide the patient's information in the designated fields. Enter the patient's last name and first name followed by their date of birth in the specified format (mm/dd/yyyy). Fill in the patient's address, city, province, and postal code.
3. In the statement of medical history section, indicate the type of diabetes the patient has by filling in the relevant information. Include the date of diagnosis and check the applicable treatment methods: Multiple Daily Injections, Pump, or Continuous Glucose Monitor.
4. Document the patient's recent A1c levels by recording each A1c value along with its corresponding date. Provide additional information on any diabetes-related complications if applicable.
5. In the supporting clinical indications, check all relevant options that apply to the patient's condition based on their medical history.
6. Fill in the physician information section accurately. Provide the physician's name, hospital/clinic name, address, city, province, postal code, telephone number, fax number, and email address.
7. Ensure the physician certifies the information provided is true, accurate, and complete by signing the document. Include a date in the required format (mm/dd/yyyy).
8. Once all fields are completed, you can save your changes, download a copy of the filled form, or print it out for mailing or faxing to Animas Canada at the provided contact information.

Start your online application to submit the Certificate of Medical Necessity today!