Get (841234-p)

Filing the (841234-P) reimbursement medical form online can streamline your claim process. This guide will help you navigate each section of the form with clear instructions, ensuring all necessary information is accurately provided.

Follow the steps to complete the form online effortlessly.

1. Click ‘Get Form’ button to obtain the document and open it in your online editor.
2. In Part 1, fill in the patient's details including their name, passport or ID number, and contact information. Be sure to provide an accurate policy number and insurer name.
3. Indicate the name of the individual to whom the payment should be issued and include their bank details, specifically the bank name and account number, to facilitate prompt payment.
4. For Part 2, ensure the attending doctor completes the treatment details. This includes confirming whether the patient was referred and providing admission and discharge dates, symptoms, and diagnosis.
5. In the treatment section, specify if the treatment relates to any specified illness categories, and document any procedures or investigations done.
6. Proceed to Part 3 by detailing the hospitalization costs. Attach all original invoices and receipts to support your claim.
7. In Part 4, list any lab tests, x-rays, angiotests, or other investigative reports that should be attached to the claim.
8. Complete Part 5 by providing your employer’s details, including their name, address, and contact information.
9. In Part 6, disclose any other insurance policies you may have, indicating each insurance company's name, policy number, type of policy, and coverage amount.
10. Finally, in Part 7, provide your consent by signing the form and including the date along with your name and relationship.
11. After you have completed all sections, review the form for any errors and make necessary corrections. Once satisfied, save your changes, download, print, or share the document as needed.

Start filling out your (841234-P) form online today for a smoother claims process.