Get the free Intimation of Hospitalization format Download - HSCL

CLAIM INTIMATION (To be filled and submitted to MD INDIA on admission of the patient in the Hospital) Date: Name of Policyholder: Name of Patient: Age: yrs Sex: M / F MD India ID number: Policy No.

How to fill out intimation of hospitalization format

How to fill out intimation of hospitalization format:

1. Start by entering your personal details such as name, address, contact number, and policy number in the designated fields.
2. Next, mention the date of hospitalization and the expected duration of the stay. Provide accurate information to ensure smooth processing of your claim.
3. Specify the reason for hospitalization, whether it is due to an accident, illness, or any other medical condition.
4. Include the details of the hospital where you are admitted, such as the name, address, and contact information.
5. Provide the name and contact details of the attending doctor or specialist who is treating you during the hospitalization.
6. If you have availed any pre-authorization for hospitalization or undergone any surgical procedures, mention the details in the format.
7. Attach any relevant medical reports, test results, or invoices along with the intimation form to support your claim.

Who needs intimation of hospitalization format?

1. Individuals who have purchased health insurance policies and require hospitalization for medical treatment are required to fill out the intimation of hospitalization format.
2. This format serves as a formal communication between the policyholder and the insurance company, informing them about the hospitalization to initiate the claim process.
3. Employers who provide health insurance coverage to their employees may also require their employees to fill out the intimation of hospitalization format in case of any medical emergencies.

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What is intimation of hospitalization format?

Intimation of hospitalization format is a document that needs to be submitted to inform the relevant authorities about a hospitalization event.

Who is required to file intimation of hospitalization format?

The individual who has been hospitalized or their representative is required to file the intimation of hospitalization format.

How to fill out intimation of hospitalization format?

The intimation of hospitalization format can be filled out by providing the required details such as name of the patient, date of hospitalization, reason for hospitalization, etc.

What is the purpose of intimation of hospitalization format?

The purpose of intimation of hospitalization format is to keep the authorities informed about hospitalization events and facilitate necessary actions.

What information must be reported on intimation of hospitalization format?

The intimation of hospitalization format must include information such as name of the patient, date of hospitalization, name of the hospital, reason for hospitalization, etc.