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NON HOSPITALIZATION CLAIM From The New India Assurance Company Limited Registered and Head Office New India Assurance Building, 87 M G Road, Fort, Mumbai TATA CHEMICALS LIMITED *LOT NO. *CLAIM NO
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How to fill out a non-hospitalization form:

01
Start by carefully reading the instructions provided on the form. Make sure you understand the purpose of the form and the information it requires.
02
Fill in your personal details accurately, including your full name, address, contact information, and any other requested personal identification information.
03
Provide information about your healthcare provider or physician. This may include their name, address, phone number, and any other relevant contact information.
04
Indicate the date you are requesting the non-hospitalization coverage for. This is typically the date on which your non-hospitalization treatment will begin.
05
Specify the reason for your non-hospitalization treatment. Provide a detailed description or enter the specific code given by your healthcare provider, if applicable.
06
If requested, provide additional information about any other healthcare professionals involved in your treatment, such as specialists or therapists.
07
Review the form for accuracy and completeness before submitting it. Make sure all the required sections are filled out and any necessary supporting documentation is attached.
08
Follow the submission instructions provided on the form. This may include mailing it to a specific address or submitting it electronically through a designated portal.

Who needs a non-hospitalization form?

01
Patients who require medical treatment but do not require hospitalization may need to fill out a non-hospitalization form.
02
Individuals who are seeking coverage for non-hospitalization treatments from their insurance providers or healthcare plans may be required to fill out this form.
03
People who are undergoing outpatient procedures, receiving home healthcare, or participating in certain specialized therapies may need to complete a non-hospitalization form to request coverage for their treatment.
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The non hospitalization form is a document that needs to be filled out to report any medical treatment or care received outside of a hospital setting.
Any individual who receives medical treatment or care outside of a hospital setting is required to file a non hospitalization form.
To fill out a non hospitalization form, one must provide details of the medical treatment received, including the name of the healthcare provider, the date of treatment, and the nature of the treatment.
The purpose of the non hospitalization form is to document any medical treatment received outside of a hospital setting for record-keeping and insurance purposes.
The non hospitalization form must include details such as the name of the healthcare provider, date of treatment, nature of treatment, and any follow-up care required.
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