 IWeb
User Guide
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Health Insurance Claim Form (Louisiana)
This generates a health insurance claim form for a specific patient that can be filled out online and printed. You must first search for a select a patient.
Generate the Form
To generate this form, click the Reports > State Reports > Patient Specific > Health Insurance Claim Form link. The Health Insurance Claim Form page opens in a new browser tab with the patient-specific fields automatically populated. Select the options (i.e., Patient Relationship to Insured, Outside Lab Yes/No) as necessary on the form and use the browser's print function to print the form.
Example Form
The following image is of an example Health Insurance Claim form:
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