Get Ohp Medical Travel Multiple Visit Verification Form

Filling out the OHP Medical Travel MULTIPLE VISIT Verification Form online is essential for individuals who have multiple appointments with the same medical provider. This guide offers a clear and structured approach to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete your form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your client name at the top of the form. Ensure your name is spelled correctly and matches the documentation you have.
3. Next, fill in the details of your clinic or facility name along with the facility address. It is important to provide accurate information to avoid delays.
4. Provide your date of birth (DOB) and phone number in the respective fields. These details may be necessary for verification purposes.
5. For each visit, input the visit date, appointment time, and the name of the person you saw. Ensure to complete each section thoroughly.
6. After providing the visit details, ensure that either the person seen or their authorized representative signs the form in the designated area.
7. Next, write the printed name of the signer along with the date they signed the form.
8. In the visit purpose field, clearly indicate the reason for each appointment. Then, document the time you completed the visit.
9. Repeat steps 5 through 8 for additional visits as required, ensuring that all details are accurately recorded.
10. At the end of the form, indicate your requests for mileage, lodging, and meal assistance, tick off the appropriate boxes as it applies to you.
11. Once you have filled out all required sections of the form, take a moment to review everything for accuracy.
12. Finally, save your changes, and if necessary, download, print, or share the completed form as required.

Complete the OHP Medical Travel MULTIPLE VISIT Verification Form online today to ensure your travel reimbursements are processed efficiently.