Get Central Zone Home Collection Eligibility Form

Completing the CENTRAL ZONE HOME COLLECTION ELIGIBILITY FORM is essential for requesting laboratory home collection services for patients confined to their homes for medical reasons. This guide will provide step-by-step instructions to help ensure that you accurately fill out the form online.

Follow the steps to successfully complete the eligibility form.

1. Click 'Get Form' button to access the eligibility form and open it in your chosen online application.
2. Begin by entering the assessment date in the specified format (dd MON yyyy), making sure to use the appropriate date for when the eligibility is being evaluated.
3. Fill in the patient's name in the designated field, ensuring that it matches the name on their medical records.
4. Provide the patient's personal health number (PHN) in the required section for identification purposes.
5. Tick the most suitable option that reflects the reason for the patient's confinement to home, selecting from major illness, post-operative recovery, oxygen needs, mental health issues, or other specified reasons.
6. Indicate the expected duration of the eligibility for home collection services, specifying the time in weeks or months, with a maximum of one year.
7. Enter the physician's name as the individual completing the form to ensure accountability and proper communication.
8. Sign the form to confirm compliance with the outlined criteria for home collection eligibility.
9. Complete a laboratory requisition form, writing 'Home Collection' clearly on it to ensure correct processing.
10. Finally, send or fax the completed eligibility form along with the laboratory requisition to the appropriate laboratory.

Ensure you have all necessary documents completed correctly to provide patients with the best care; complete the documents online today!