Get Demande De Coloscopie Longue - Csss-sommetscom

Filling out the DEMANDE DE COLOSCOPIE LONGUE is an essential step in the process of requesting a colonoscopy. This guide will provide you with clear, step-by-step instructions to ensure that you accurately complete the form and submit your request online.

Follow the steps to complete your request seamlessly.

1. Click the ‘Get Form’ button to access the DEMANDE DE COLOSCOPIE LONGUE form and open it in your document editor.
2. Begin by entering the user's full name in the 'Nom et prénom de l’usager' section. This is required information to identify the individual requesting the procedure.
3. Next, provide the name of the user's mother in the corresponding field. This may be used for identification purposes.
4. Fill in the user's health insurance number in the ‘N° d’assurance maladie’ field. This is crucial for processing the request.
5. Enter the user’s postal code in the 'Code postal' box to ensure correct geographic identification.
6. Specify the source of the request under 'Provenance de la demande.' This could be from a hospital, clinic, or another healthcare provider.
7. Input the user's date of birth in the 'Date de naissance (A, M, J)' section, following the specified format.
8. Provide the user's address in the 'Adresse (n°, rue)' section to ensure correspondence is directed properly.
9. Fill out any additional contact information, including cellular and telephone numbers, as indicated in the appropriate sections.
10. Indicate the referring physician's name and contact details, including their license number if applicable.
11. Define the urgency of the colonoscopy by selecting the appropriate priority level based on the provided medical indications.
12. Review all entered information for accuracy to avoid delays in processing the request.
13. Once completed, you can save your changes, download a copy for your records, print the form for submission, or share it as instructed.

Complete your DEMANDE DE COLOSCOPIE LONGUE online today to expedite your request.