Get D9292

The D9292 form is essential for requesting financial approval for MRI or PET scans. This guide will provide you with clear and organized instructions to ensure a smooth online submission process.

Follow the steps to successfully complete the D9292 form online.

1. Click 'Get Form' button to access the D9292 form and open it in your preferred document editor.
2. Begin by entering the date on the form. This ensures that your request is timestamped correctly.
3. Fill in the details for the entitled person: include their DVA file number, full name, and select the card type (Gold or White).
4. If applicable, indicate the specific condition for the White Card in the designated section.
5. Specify the type of MRI or PET scan required and confirm if a referral is attached by selecting 'Yes' or 'No'.
6. Provide a clinical reason for the scan to justify the request.
7. Enter the details of the referring provider: include their provider number, name, and telephone number. The email field is optional.
8. Next, fill in the servicing provider details, including the provider number, name, and address, along with the postcode.
9. Indicate the type of machine license the servicing provider holds and include their telephone number.
10. Input the provider's email address if applicable, and list the item numbers related to the requested service.
11. Finally, include the date of the requested service and the associated fee for the scan.
12. Review all entries ensuring they are complete and accurate to avoid delays in the processing of your request.
13. Once all sections are filled out correctly, you can save your changes, print the form, or email it directly.

Complete and submit the D9292 form online today to ensure timely approval for your MRI or PET scan.