Get Polmed Hiv Application Form

Filling out the Polmed HIV Application Form online can be straightforward if you follow the proper steps. This guide will walk you through each section of the form, ensuring you provide all necessary information accurately.

Follow the steps to complete the application form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the Principal Member Details. Provide your first name, surname, medical scheme, gender, and membership number in the designated fields.
3. Next, complete the Patient Details section. Include the first name, surname, dependent code, gender, ID number, and date of birth of the patient.
4. In the Treatment Support section, provide your confidential email and postal address for receiving confidential mail. Include your contact numbers for work, home, and cellphone, and indicate your preferred form of communication.
5. Identify a next of kin or trusted friend who can be contacted in case you are unreachable. Fill in their first name, surname, and contact details.
6. Sign the consent statement acknowledging that all provided information will be used to determine access to HIV benefits and that you authorize your medical practitioners to share necessary information.
7. The Doctor must complete their respective section, providing details such as surname, practice number, email address, and telephone number.
8. Enter clinical history details including the diagnosis date of HIV infection, screening and confirmatory test types, and details of any current or past treatments.
9. Provide clinical examination results, including weight, height, pregnancy status if applicable, and any significant clinical findings.
10. Upon completion of all sections, review the form for accuracy before saving changes. Users can then download, print, or share the completed form for submission.

Start filling out the Polmed HIV Application Form online today to ensure access to necessary support and treatment.