Get Ppn Declaration Form

This guide provides step-by-step instructions for completing the Ppn Declaration Form online. By following these clear steps, users can ensure that all necessary information is accurately provided for a smooth processing experience.

Follow the steps to complete the Ppn Declaration Form online.

1. Press the ‘Get Form’ button to initiate the process and access the form for completion.
2. In the ‘Name of the Hospital’ field, enter the name of the hospital where the patient is being treated. Following that, specify the date in the format provided.
3. Fill in the address of the hospital accurately to ensure proper identification.
4. Provide the patient's name in block letters in the designated field, followed by their age and sex.
5. Complete the patient's IP number and UHID number as applicable.
6. Enter the mobile number of the patient for any required communication purposes.
7. Indicate the date and time of admission, as well as the anticipated date and time of discharge.
8. Input the patient's full address to ensure clarity and correct information.
9. Next, fill out the name of the attendant who is accompanying the patient along with their relationship to the patient.
10. Provide the mobile number of the attendant and any relevant address information.
11. In the section regarding insurance policy, strike out any options that do not apply to the patient. If the patient has insurance, include the policy number and insurance company name.
12. Indicate whether the patient has opted for the eligible room category under the insurance policy by selecting yes or no.
13. If the policyholder wishes to opt for additional facilities, provide the name of the facility and the associated cost in both numerical and written format.
14. Ensure that the declaration regarding the agreement to pay for additional services is understood and sign accordingly.
15. Finalize the form by signing in the designated area. Additionally, include the name of the patient or the patient's attendant along with the hospital seal.
16. Once all sections are filled out and verified for accuracy, save any changes, download, print, or share the form as required.

Complete your Ppn Declaration Form online today for efficient processing!