Transmed Medical Fund

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Transmed Medical Fund

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Forms

Membership

picture_as_pdf Application for membership

picture_as_pdf Dependant registration form

picture_as_pdf Membership amendment form

picture_as_pdf Contact information of dependants 18 years and older

picture_as_pdf Application for continuation of membership for pensioners

picture_as_pdf Application for continuation of membership following death

picture_as_pdf Ex gratia assistance

picture_as_pdf Member consent form

picture_as_pdf Affidavit for confirmation of income

Healthcare provider

picture_as_pdf Submit or change banking details for a medical practice

Authorisations

picture_as_pdf Chronic medication advance supply request form

picture_as_pdf Chronic Medicine Risk Management Programme application

Programme enrolment

picture_as_pdf Palliative care application form

picture_as_pdf HIV YourLife Programme application form

picture_as_pdf PMB Treatment Plan application form

picture_as_pdf Integrated care application form

picture_as_pdf Maternity Programme enrolment form

Required information

Practice Name
The Doctor's registered practice name.
Practice Number
The Doctor's registered practice number.
Medical Aid
This should state "BP Medical Society"
Membership Number
Required to be the same number as on your medical aid card
Patient's Name
Full name of the patient
Patient's Birthdate
Birthdate of the patient, year month and day
Patients Dependant Code
This is a 2 digit code, eg. "01"
Date of service
Date of visit
ICD Code
This is a diagnosis code, eg."J11.1"
Tariff Code
Particular code for the service you received, often a 3 to 4 digit number.
Treatment cost
Amount billed for the goods or service.
Referring Doctor - Name and Practice Number
In the case of a referral, the doctors registered practice name and number is required.

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