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SHORT FORM MEDICAL INSURANCE APPLICATION Please check all details, then complete the relevant areas of the form and return it to: BSP Health Care (Fiji) Limited, First Floor, BSP Life Center, Thomson

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Start by carefully reading all the instructions provided on the form. It is important to understand what information is required and how to appropriately fill out each section.

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Begin by providing your personal details such as your full name, date of birth, gender, and contact information. Ensure that all the information is accurate and up to date.

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Short form - medical is a shortened version of a medical report that contains essential information about a patient's health.

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The purpose of short form - medical is to provide a concise summary of a patient's medical information for easy reference by healthcare providers.

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Information such as patient's name, date of birth, medical history, current symptoms, diagnosis, treatment plan, and healthcare provider's contact information must be reported on short form - medical.

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