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Opmed Chronic Forms 2012-2023
Number
Dr Speciality
E-mail Address
Dr Contact Numbers: (Rooms)
(Fax)
(Cell)
Clinical Entry Criteria for the CDL Conditions to be Completed by the Treating
Physician:
In order for a patient /beneficiary to qualify for the CDL benefit, the medical practitioner must supply the relevant information per
disease condition on the following pages.
Authorisations are subject to the Mediscor Basic formulary. The formulary can be viewed at www.mediscor.net
The attending medical practitioner’s...
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