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PET SCAN CLINICAL CERTIFICATION REQUEST FORM FAX: 800.540.2406 Please be advised that all questions must be answered completely. Failure to do so may delay a determination. Patient name: DOB: Insurance
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How to fill out pre-cert pet fax 101007-2doc
How to fill out pre-cert pet fax 101007-2doc:
01
Start by entering the date at the top of the document.
02
Fill in the pet owner's information, including their name, address, and contact details.
03
Provide the details of the pet, such as its name, breed, age, and any specific medical conditions.
04
Indicate the reason for the pre-certification, such as a scheduled surgery or procedure.
05
Fill in the attending veterinarian's information, including their name, address, and contact details.
06
Include any additional information or documentation that may be required for the pre-certification process.
07
Review the completed form for accuracy and ensure all necessary information has been provided.
08
Sign and date the form to confirm your authorization and understanding of the pre-certification process.
09
Submit the filled-out pre-cert pet fax 101007-2doc according to the specified instructions.
Who needs pre-cert pet fax 101007-2doc:
01
Pet owners who are planning to have their pet undergo a medical procedure or surgery that requires pre-authorization.
02
Veterinarians who need to communicate the necessary information and documentation to the insurance provider for pre-certification.
03
Insurance companies that require pre-certification for certain pet medical procedures to ensure coverage and manage costs effectively.
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