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Colonial Life HOSPITAL CONFINEMENT/OUTPATIENT SURGERY FAX: 18008809325 Telephone: 18003254368Hospital Confinement/Outpatient Surgery Claim FAX this direction FAX this form: 18008809325From:Or mail:
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01
Start by opening the 100713-9 hospital confinementindd form.
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Fill in the patient's personal information such as name, date of birth, and address in the designated fields.
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Provide the patient's medical history and any relevant information related to the hospital confinement.
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Fill in the dates of admission and discharge for the hospital confinement period.
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Include details about the hospital or medical facility where the confinement took place.
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Provide information about the treating physician and any other healthcare professionals involved in the patient's care.
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If applicable, fill in details about the insurance coverage and any claims related to the hospital confinement.
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Submit the filled out 100713-9 hospital confinementindd form to the relevant healthcare or insurance authority.
Who needs 100713-9 hospital confinementindd?
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The 100713-9 hospital confinementindd form is needed by individuals or their representatives who have undergone hospital confinement and need to report or provide information about the confinement to healthcare or insurance authorities. This form helps in documenting the details of the confinement, including patient information, medical history, dates of admission and discharge, treating physician's information, and insurance coverage if applicable.
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