Resolution Health|Pre Authorisation

Pre Authorisation

To apply for authorisation please complete the details below:


Today’s date
2010/03/11
Membership no
Patient’s name
Date of Birth
Members contact Tel no
Cell phone no
Members E-mail Address
Hospital practice no
Hospital name
Hospital Tel no
Dr’s practice no
Dr’s name
Dr’s Tel no
Date of admission
Expected length of stay
Diagnosis
Procedure codes
Return e-mail address
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Members handbook

The Members Handbook is your guideline in terms of your annual benefits, contributions, all protocols and scheme rules.

chronic authorisation application

Click on the link below to download a PDF version of the Chronic Authorisation Application form