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Get Au D919 2013-2025
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How to fill out the AU D919 online
The AU D919 form is an important document for claiming dental treatment services. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.
Follow the steps to successfully fill out the AU D919 online.
- Click ‘Get Form’ button to access the AU D919 and open it for editing.
- Begin by entering patient details. Input the patient's Department of Veterans’ Affairs (DVA) file number and full name. If the file number is unknown, provide the patient's address, date of birth, and phone number as indicated in the shaded section.
- Complete the claimant details section. Enter the provider number, name, address, and telephone number of the claimant. If the claimant did not provide the services directly, list the name of the practitioner who did and note if they are a locum.
- In the claimant declaration section, the claimant must sign and date this declaration after the treatment is completed and/or when submitting the form for payment.
- Proceed to the record of treatment section. Document the date of service, item number, tooth number, and amount claimed. The patient must sign and date each item that reflects the dental treatment received.
- After completing all sections, review the form for accuracy. Users can then save changes, download the completed form, print it, or share it as necessary.
Start filling out your AU D919 online today for a seamless claiming process.
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