Get the free D139- Smoking Questionnaire- Claimant D139- Smoking Questionnaire- Claimant - dva gov

IMPORTANT Folio Smoking Questionnaire Claimant This form is in connection with your claim for pension and medical treatment and the information you supply will assist in deciding eligibility for benefits

How to fill out d139- smoking questionnaire- claimant

How to fill out d139- smoking questionnaire- claimant:

1. Start by carefully reading the instructions provided on the form. Ensure that you understand the purpose of the questionnaire and the specific information that needs to be provided.
2. Begin by providing your personal details such as your full name, contact information, and any other required identification information.
3. Follow the instructions on the form to indicate whether you are a current or former smoker. If you are currently smoking, provide details about the number of cigarettes or tobacco products you consume on a daily basis. If you have quit smoking, provide the date on which you quit.
4. Provide information about any previous attempts to quit smoking, including details about the methods or programs used and their effectiveness.
5. Answer any additional questions on the form regarding your smoking habits, such as the duration of your smoking history and any associated health conditions.
6. If applicable, provide any relevant medical records or supporting documents along with the completed form.
7. Review the completed form to ensure that all the required fields have been filled out accurately and comprehensively.
8. Sign and date the form in the designated section to acknowledge the accuracy of the information provided.

Who needs d139- smoking questionnaire- claimant?

1. Individuals who are filing a claim related to smoking-related health issues may need to fill out the d139- smoking questionnaire- claimant. This form is typically required by insurance companies, healthcare providers, or legal entities to gather information about an individual's smoking history and its potential impact on their health.
2. Employers or organizations that offer smoking cessation programs or health insurance policies may also require their employees or policyholders to complete this form as part of the enrollment process or for the assessment of applicable premiums.
3. Additionally, healthcare professionals, such as doctors or specialists, may request their patients to fill out this form to gather crucial information about smoking habits, particularly if it is relevant to their medical diagnosis or treatment plan.

For pdfFiller’s FAQs

What is d139- smoking questionnaire- claimant?

d139- smoking questionnaire- claimant is a form used to gather information about a claimant's smoking habits in relation to a specific claim.

Who is required to file d139- smoking questionnaire- claimant?

The claimant who is involved in a specific claim is required to fill out and file the d139- smoking questionnaire- claimant.

How to fill out d139- smoking questionnaire- claimant?

The d139- smoking questionnaire- claimant should be completed accurately and truthfully by providing details about the claimant's smoking history and habits.

What is the purpose of d139- smoking questionnaire- claimant?

The purpose of d139- smoking questionnaire- claimant is to collect information about the claimant's smoking habits which may impact a specific claim.

What information must be reported on d139- smoking questionnaire- claimant?

The d139- smoking questionnaire- claimant requires information such as the claimant's frequency of smoking, duration of smoking, and any attempts to quit smoking.

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