Get Hi Dhs 1125a 2016-2025

This guide provides a detailed walkthrough for completing the HI DHS 1125A form, a critical document for individuals seeking assistance after an accident. By following these instructions, you will be able to fill out the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the name of the injured person in the designated fields, including their last name, first name, and middle initial. Ensure accuracy to avoid processing delays.
3. Input the case number and identification number in the appropriate sections provided.
4. Fill in the sex, address, social security number, and case name (if different from the injured person's name) as instructed.
5. Record the date of birth and the date of the accident in the specified fields.
6. Select the type of accident from the options provided, ensuring you mark all that apply.
7. In the space provided, give a clear description of how the accident occurred, including the time and location.
8. Describe the type of injury sustained by the beneficiary, using specific terms for the injuries experienced.
9. Indicate the extent of the injury, selecting from options such as seriously or slightly.
10. List the names of any medical professionals or facilities that treated the beneficiary.
11. Indicate whether the beneficiary is still receiving medical care for the injury by selecting the appropriate option.
12. Provide information about any person or property owner who may be at fault for the accident, including insurance details.
13. State whether the beneficiary intends to file a suit regarding the accident.
14. If applicable, enter the date of settlement and the attorney’s contact information. Specify if the beneficiary has legal representation.
15. Document the beneficiary’s insurance coverage status at the time of the accident, selecting from the options listed.
16. Indicate if the beneficiary was injured in their own vehicle and provide details as necessary.
17. State whether a police report was filed and provide the report number if available.
18. Use the final section to provide any additional information relevant to the case that could not be included in the previous sections.
19. Review all entered information for accuracy and completeness. Once confirmed, save your changes.
20. Download, print, or share the completed form as per your needs.

Complete your HI DHS 1125A form online today and ensure that you provide the necessary information for your case.