Get Unified Healthcare Group

This guide provides comprehensive instructions on how to complete the Unified Healthcare Group pathology request form online. It is designed to assist users in accurately filling out the necessary details for their life insurance needs.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Unified Healthcare Group form and open it for editing.
2. In the 'Applicant Details' section, enter your UHG or HSN ID number, given name, surname, address, state, postcode, date of birth, and indicate your gender by selecting either 'Male' or 'Female'.
3. Moving to the 'Pathology Data Entry' section, provide the details of the doctor by filling out the 'Results To' field with the doctor's name and ensuring that the duplicate copy results are directed to the correct fax number.
4. Indicate the tests requested for life insurance purposes by clearly marking each test with an 'X'. Be sure to include any additional tests necessary for your application.
5. In the 'Collector Instructions' area, specify the number of hours fasting and the number of tubes collected. Ensure the collector has marked the proper tests that have been completed.
6. Complete the 'Identification & Collector’s Declaration' section by identifying the type of identification provided, entering the collector's name, collection time, and signature.
7. In the 'Privacy Statement & Patient/Insurance Applicant’s Declaration' section, provide your signature and date on the declaration, acknowledging that you consent to the analysis and release of your results.
8. Once all fields are completed, review the form for accuracy, then save your changes, download, print, or share the form as needed.

Complete your Unified Healthcare Group form online today for a seamless application process.