Get Daman Form

The Daman Form is essential for filing dental claims with the National Health Insurance Company. This guide will provide you with clear and supportive instructions to complete the form online successfully.

Follow the steps to fill out the Daman Form online

1. Press the ‘Get Form’ button to acquire the Daman Form and open it in your preferred editor.
2. Input the patient’s name as it appears on the health insurance card in the designated patient’s details section.
3. Next, enter the card ID number in the specified field to ensure proper identification of the patient.
4. Fill in the provider’s reference number, which may be indicated as MR, ensuring accuracy in the claim processing.
5. Enter the provider’s name, date of service, and include the signature of the cardholder to validate the claim.
6. In the medical details section, indicate the chief complaint, duration, and diagnosis as filled out by the dentist.
7. Provide details of the planned dental treatment, including service description and the tooth number/letter.
8. List the total cost of services and required medications in the corresponding fields.
9. Have the treating dentist include their name, date, signature, and stamp in the appropriate sections.
10. Finally, review all entries for accuracy, then save changes, download, or print the completed form for submission.

Complete your Daman Form online today for a smooth claims experience.