Get Canada Life Plan Member Confirmation Of Illness Form 2020-2025

This guide provides clear and supportive instructions on how to effectively fill out the Canada Life Plan Member Confirmation Of Illness Form online. It is designed to assist individuals experiencing symptoms or who have a clinical diagnosis of COVID-19 in submitting their information accurately.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your editing interface.
2. Begin by entering your policy number and certificate number in the designated fields. Next, provide the plan member's name and plan sponsor's name.
3. Record the date when your symptoms first appeared and the first day you were absent from work, using the format (dd/mm/yyyy).
4. Indicate the symptoms associated with your illness by selecting from the list provided. You can check multiple options to accurately describe your condition.
5. If applicable, describe any other health problems that may affect your recovery, such as diabetes or respiratory illness.
6. Provide the date of your medical consultation related to COVID-19 and specify the healthcare provider you consulted (e.g., physician or clinic).
7. Fill in the date of your COVID-19 test and the facility where the test was conducted. Report the test result as positive, negative, or pending, and include the expected date for pending results if necessary.
8. Indicate whether you have been instructed to quarantine. If yes, provide the date when the quarantine began and the expected end date.
9. Answer questions regarding your next medical appointment and your expected return date to work. Indicate if you have the capability to work from home.
10. Include any additional details about your illness that you feel are important for the review process.
11. Finally, certify that your statements are true and complete by signing the form and providing your contact information, including your name and phone number. You can then save your changes, download the form, or share it as needed.

Complete your Canada Life Plan Member Confirmation Of Illness Form online to ensure your submission is processed promptly.