Get Medical Claims Authorisation Form (single ...

Completing the medical claims authorisation form online is a straightforward process that ensures you provide the necessary permissions for withdrawing funds from your Medisave account for medical expenses. This guide will walk you through each section of the form to help you fill it out accurately and efficiently.

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. In Part I, provide the particulars of the patient. Fill in the patient's name, NRIC/CPF number, date of birth, and any applicable information regarding their insurance status under MediShield.
3. Move to Part II and enter the particulars of the Medisave account holder. Include their name, NRIC/CPF number, date of birth, and indicate their relationship to the patient by ticking the appropriate option.
4. In Part III, specify the purpose of the Medisave withdrawal. Provide the medical institution's name, hospitalization/treatment dates, and details regarding outpatient treatments if applicable.
5. Part IV requires the Medisave account holder to make declarations and authorizations. Carefully read each statement and check the boxes as necessary, ensuring you comply with the regulations when authorizing the withdrawal from your Medisave account.
6. In Part V, authorize the disclosure of medical information by signing as required, if the patient is not the Medisave account holder. This involves confirming that the medical institution may share information for the required purposes.
7. Once all sections are filled out, review the form for accuracy. Finally, save your changes, download, print, or share the form as needed to complete the submission.

Start completing your medical claims authorisation form online today for a seamless experience.