Get Ppn Declaration Form

Filling out the Ppn Declaration Form online is a straightforward process, designed to collect essential information about the patient and their insurance status. This guide offers a step-by-step walkthrough to help you complete the form accurately and efficiently.

Follow the steps to fill out the Ppn Declaration Form online

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin by entering the name of the hospital, followed by the date on which the form is being filled out. Ensure these details are correct for proper documentation.
3. In the patient name field, use block letters to clearly write the full name of the patient. Then, fill in the patient's age and sex.
4. Provide the patient's IP number and UHID number, followed by the patient’s mobile number.
5. Record the date and time of admission as well as the date and time of discharge to ensure accurate and timely care records.
6. Fill in the complete address of the patient to facilitate communication and contact if needed.
7. Next, enter the name of the attendant along with their relationship to the patient.
8. Provide the attendant's mobile number and address to ensure they can be reached easily if required.
9. You will find a section for declaring the insurance policy status. If the patient does not have an insurance policy, clearly state that. If they do, note the policy number and insurance company details.
10. Indicate whether the patient opted for the eligible room category under their policy by selecting 'Yes' or 'No'.
11. If the policyholder wishes to avail themselves of better facilities, provide the name of the additional facility and the associated costs in both figures and words.
12. Ensure to read and understand the implications regarding additional charges for better facilities, taking note of your financial responsibilities.
13. Finally, sign and date the form in the designated areas. Ensure that the name of the patient or patient's attendant and a hospital representative are also included, along with the hospital seal.
14. Once completed, you can save the changes made to the form, and have options to download, print, or share the document as needed.

Start completing your Ppn Declaration Form online today for a seamless process.