MEDICAL EXPENSES REIMBURSEMENT CLAIM FORM (HITPA)

REIMBURSEMENT CLAIM FORM HITPA  

https://drive.google.com/file/d/1G2vjfuZ4KEqu3vADGcJeOaVtoOOwxGO2/view?usp=sharing

PART OF FORM

1   CLAIM FORM -    PART - A

2   GUIDANCE FOR FILLING CALIM  PART - A TO BE FILLED IN BY THE INSURED

3   CLAIM FORM -   PART - B

4   GUIDANCE FOR FILLING CLAIM   PART - B TO BE FILLED IN BY THE HOSPITAL

5   CONSENT FORM