Ecuasanitas Claim Form: Format, Filling and MORE

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The Ecuasanitas Claim Form It is a document that in Ecuador has a lot of relevance and here we are going to explain why. If you are a resident of this country, it is important that you consider what we have just mentioned. And, that you read in detail and in detail what we are going to present below in each of the sections to be developed.

This article is designed so that you are well informed in relation to Ecuasanite Claim Form and thus not present problems when requesting it. We will tell you from the download format, its due process of filling, the utility it has, its requirements and more. Additionally, we will tell you a little about Ecuasanitas.

Stay here and find out more about the points that we mention in the following sections!

Ecuasanitas Claim Form Format

As the title of this section indicates, here we are going to tell you about the format in which you are going to get the Ecuasanitas Claim Form. As we well know, this is a document that has great importance and it is considerably opportune that you know how to download it and have it at hand. You must read carefully and in detail each of the things that we will tell you below.

First of all, you have to know that this is a document which you will get digitally, that is, it is online. You have the possibility of being able to obtain it through the Ecuasanitas website or you can also obtain it by doing click here. This body is in charge of supplying various papers and forms related to its functions and services in Ecuador.

When you have achieved the entry, either to the web portal or to the link indicated above, the Ecuasanitas Claim Form. Through it you will be able to download it for when necessary.

You can download it by pressing the icon that is positioned in the upper right part of the screen, in the form of an arrow. The format in which the form will be saved is in PDF, it is a fairly common format and easy to use.

Once you have managed to download the document, on the device where you are working. This is to take the necessary precautions in case of any kind of problem. In addition, it is a document that does not weigh almost and with a secure backing.

Filling of the Ecuasanitas Claim Form

This is one of the most common concerns in relation to Ecuasanitas Claim Form. This form consists of two (2) pages and each one with its respective groupings of data to fill out and complete in an effective way. This task is completed through a series of simple steps that we are going to expand on below, keep reading and find out more.

It is worth highlighting the importance of reading this carefully, so that you do not forget any details and are up to date with everything. As we already made the respective mention, the Ecuasanitas Claim Form has a fairly simple and practical completion process to understand. Next, we are going to explain to you, by means of a list, every detail about what you must do and the respective order that you must take.

Step by step to fill out the Ecuasanitas Claim Form

  1. The first step that you must carry out will be the proper verification of your internet connection from the device on which you wish to carry out this procedure.
  2. You will go on to access the internet search engine that is of your preference and easy to use.
  3. Once in it, you will go to search, in the search bar, the Ecuasanitas website, this to be able to search the form. You also have the possibility of entering the link indicated in the previous section.
  4. After entering and displaying the form on your screen, the next thing you will do is download the file to your computer. This can be done by clicking on the icon at the top of the screen.
  5. After the download, you will open it and verify that it has downloaded well. Then you will begin to fill each empty space with the data that they request respectively.

It is relevant to highlight the prior knowledge of each of the parts and boxes that appear in the Ecuasanitas Claim Form. This so that you know what to put when it comes time to carry out this procedure. Read carefully each of the things that we will tell you in the next section, this in a comprehensive way and step by step.

Sections belonging to the Ecuasanitas Claim Form

  • In part A of this form you must indicate data such as the type of plan to choose. Offer your contact number, this by the applicant.
  • You must also put the full name of the company, the family, the user, the total value of the claim. Additionally, the full names and surnames of the holder together with their identification number and their telephone number.
  • To finish with this classification, the signature of said owner must go.
  • We move on to a second section, section B. This is going to need to be filled out by a doctor.
  • The first thing that will be put is the name of the patient, the date on which he was treated, his age, the identity card number. The gender, the name of the doctor who is treating you, will also be indicated.
  • On the other hand, the specialty of the doctor, the RUC, the address of the office, the city, the telephone number will be placed. The reason that refers to the current condition of the patient will be indicated if it is due to illness, pregnancy or accident.
  • For each reason there are some specifications that should be indicated, such as the reason, the query as such, the symptoms, how it happened. If you had to have any surgery.
  • It is necessary that everything that has been put is certified by means of a couple of things, the signature and the stamp of the doctor and the corresponding date of filling.
  • We continue with the next part, the C. This corresponds to its use for the medical audit authorities in Ecuasanitas.
  • Here is the date of affiliation, the day, the month and the year, the medical professional will be entered and if it is of free choice.
  • And, also, it will be indicated if at any time the provision of any of the services offered has been denied. Set as of the start date of treatment.
  • In another table they ask if there was a preexistence coverage, the previous pree, also about the current case. In relation to the current situation of the medical audit and the signature and seal of the medical auditor.
  • We come to the last part, the D. In it will be put a written authorization for the respective collection of reimbursement in cash, check or by means of deposit This for the bank account to carry out these procedures.
  • On the second page is the information regarding the requirements that will be requested for you to attach and take with the form already filled out.

Additional requirements

As mentioned in the previous section. On the second page of the Ecuasanitas Claim Form There are the requirements to be able to request the process and approval of the same. In this section of the article we will talk about them so that you have no doubts when you are going to process your form properly.


It is important that you read in detail what we are going to present to you in relation to this point to be discussed. Now, the requirements that are requested for this document are the following:

Essential requirements for the Ecuasanitas Claim Form

It is important to note that each of the fields that were filled in must be legible. Documents that are blurred, studded, amended, torn, or in poor condition will not be accepted. So make sure everything meets a good look and every single thing on it is seen.

  • The original invoices must meet the requirements of the SRI and they contain the name of the holder or patient.
  • Invoices for minors’ care must be issued in the name of the contract holder, with details of the patient’s care.
  • Original medical assistance claim form.
  • The original consultation and hospital bills.
  • Prescriptions in the name of the patient, the date, name, signature and stamp of the doctor.
  • They will ask you for the exams and procedures performed. This together with the results of the same and their reports.
  • The recipes will have to be in a way complete with your directions.

Special requirements

These will depend on the case to be presented, these are also specified on the second page of the form. Cases can be:

  • For emergency.
  • Personal traffic accidents.
  • Coordination of benefits: the plan to choose.
  • Medical expenses abroad.

Usefulness of the Ecuasanitas Claim Form

The Ecuasanitas Claim Form It is a form that has the established function of being able to give a record of the medical examinations that a person performs. This also serves to keep track of everything related to these cases and receive some type of benefits through Ecuasanitas.

It is important that you have everything that is asked of you to be able to validate it so that the process can be approved and you can be attended to. This regardless of the case you present, it can be due to illness, pregnancy or an accident that you have suffered.

What is Ecuasanitas?

This is an entity that is located in the South American country of Ecuador through which it has the task of providing medical care and medicines that have been prepaid. Through this company, they assume the responsibilities of providing a guarantee through the well-being that they provide through citizen security work.

Also, they must guarantee the health and preservation of the environment. They must make sure to maintain suitable and safe conditions to be in a healthy environment for those who work in it. Suppliers and their customers are also included here. To obtain more information about this organization, you can enter its web portal by doing click here.

What is the Ecuasanitas Claim Form?

As we have already been talking about, the Ecuasanitas Claim Form It is a document through which you have the possibility of claiming the granting of services. This in relation to the products and services that the Ecuasanitas company is destined to provide.

However, it must be remembered that in order for them to present their services to you, you must bring your respective medical records. The recipes that have been sent to you, the treatments with their indications and everything well detailed for the effects that should be produced because of this form.

We hope you liked this article We will read to you soon!

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