Get Il Hfs 3701i 2014-2025

Filling out the IL HFS 3701I form is a crucial step in obtaining coverage for a binaural hearing aid system. This guide provides clear and user-friendly instructions for completing the form online, ensuring you have all necessary information at hand.

Follow the steps to effectively complete the form online.

1. Press the ‘Get Form’ button to access the IL HFS 3701I form and open it in your preferred online editor.
2. Begin by entering the patient’s name at the top of the form, followed by their RIN (Recipient Identification Number) and birth date.
3. Indicate whether the participant's hearing was tested in an acoustically treated sound suite by checking 'Yes' or 'No.' If 'No,' provide details of where the hearing tests were conducted.
4. Enter the date the hearing tests were performed and provide the name and type of the practitioner who conducted the tests.
5. Document the hearing test results below for both ears, specifying the decibels and frequencies for the right ear and left ear.
6. Attach a copy of the comprehensive hearing tests performed. Address whether there are results from previous hearing tests reviewed by the practitioner and provide relevant dates and results if applicable.
7. Describe any past hearing devices that have been used and evaluate their effectiveness.
8. Explain the necessity for the participant to have a binaural hearing aid system.
9. Include any additional factors unique to the participant that should be considered during the prior approval review.
10. Ensure that the audiologist, physician, or practitioner signs the form and adds their degree, followed by the date of signing.
11. Once all sections are completed, save your changes, download a copy, or print the form for your records and submission.

Complete your IL HFS 3701I form online today to ensure timely processing of your hearing aid coverage.