Get Request For Bextensionb Of Treatment File No

Filling out the Request for Extension of Treatment form can be straightforward if you follow the right steps. This guide is designed to help you understand each component of the form to ensure accurate and timely submissions.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the Client Information section. Fill in your last name, first name, and middle name(s) as required. Next, include your complete mailing address, specifying your country, city or town, province or territory, and postal code.
3. In the Type of Treatment field, state the treatment being sought. Clearly describe the condition being treated to provide context.
4. Provide your provider information. Include their Medavie Blue Cross provider number, name, and complete mailing address. Ensure to include their country, city or town, province or territory, and postal code.
5. Proceed to Treatment Information. Indicate the number of treatment sessions provided so far in the current calendar year, and specify the date range of these sessions.
6. Describe the client's initial condition at the beginning of the treatment, along with the objective measurements used for assessment. This should offer insight into the effectiveness of the treatment.
7. Identify the anticipated treatment outcomes or goals and detail the methods being utilized to achieve them. Provide specific, measurable, and realistic goals, along with the corresponding modalities or methods for each identified outcome.
8. Offer a current measure of the client's condition, comparing it to the initial condition. This information is crucial for appraisal.
9. Explain how the proposed additional sessions are expected to be effective in achieving the desired outcomes, using objective evidence to substantiate your recommendation.
10. Indicate the number of additional sessions recommended within the calendar year, ensuring your reasoning is clear and supported.
11. Review all filled sections for accuracy. Save changes, and prepare the form for submission. Users may choose to download, print, or share the completed form as needed.

Complete your documents online to secure your treatment extension.