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University of Central Florida Travel Assistance, Medical Evacuation and Repatriation of Remains Benefits 20122013 Policy Year Enrollment Form Name Last First M Date of Birth MM/DD/YYY Student ID#
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How to fill out 2012-b2013b ucf medical evacuation

How to fill out 2012-b2013b UCF medical evacuation:
01
Gather all necessary personal information such as name, date of birth, and address.
02
Start by filling out the section for the insured's information, providing accurate details about the individual who requires medical evacuation.
03
Move on to the section for the policyholder's information, ensuring that all details are entered correctly.
04
Provide the details of the primary insurance coverage, including the insurance company's name, policy number, and contact information.
05
Fill in any additional insurance coverage information, if applicable.
06
Proceed to the section for the physician's information, including the name, contact details, and any relevant medical notes.
07
Fill out the section for the hospital or facility where the insured is currently located, specifying the name, address, and contact information.
08
Provide the contact details for the person who should be contacted regarding the insured's medical evacuation.
09
Indicate the mode of transportation required for the evacuation, whether it is air ambulance, ground ambulance, or other means.
10
Complete the section for the diagnosis and reason for medical evacuation, providing accurate and concise information.
11
If necessary, attach any supporting documents or medical reports that may assist in the medical evacuation process.
12
Review all the information provided to ensure accuracy and completeness before submitting the form.
Who needs 2012-b2013b UCF medical evacuation:
01
Individuals who are currently ill or injured and require transportation to a medical facility for further treatment.
02
Students or employees of the University of Central Florida who experience a medical emergency and need to be evacuated to a different healthcare facility.
03
Individuals who have purchased the UCF medical evacuation insurance and require evacuation services due to medical reasons while traveling.
Note: It is essential to consult the specific guidelines and requirements provided by the University of Central Florida or the insurance provider when filling out the 2012-b2013b UCF medical evacuation form.
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