{"id":52910,"date":"2024-12-13T06:32:03","date_gmt":"2024-12-13T03:32:03","guid":{"rendered":"https:\/\/newsblaze.co.ke\/?p=52910"},"modified":"2023-07-28T06:02:33","modified_gmt":"2023-07-28T03:02:33","slug":"nhif-change-of-facility-hospital-form","status":"publish","type":"post","link":"https:\/\/newsblaze.co.ke\/nhif-change-of-facility-hospital-form\/","title":{"rendered":"NHIF change of facility, hospital form"},"content":{"rendered":"

NHIF change of facility, hospital form<\/p>\n

<\/a>APPENDIX3<\/h1>\n

NHIF 38<\/strong><\/p>\n

ISSUE No. 2<\/strong><\/p>\n

NATIONAL HOSPITAL INSURANCE FUND<\/strong><\/p>\n

P .O. BOX 30443 – 00100 NAIROBI, KENYA.<\/p>\n

E-Mail:<\/strong> info@nhif.or.ke<\/a><\/p>\n

Website:<\/strong> www.nhif.or.ke<\/a><\/p>\n

CHOICE OF OUTPATIENT MEDICAL FACILITY FORM<\/strong><\/p>\n

Guidelines:<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

    \n
  1. Principal Members are required to forward a duly completed form to the nearest NHIF<\/li>\n
  2. To select a medical facility, please refer to the list of NHIF accredited health facilities available on the NHIF Website and NHIF offices<\/li>\n
  3. To access benefits one MUST be duly registered by filling NHIF Registration Form (NHIF 2) and declare their<\/li>\n
  4. A copy of the Principal Member\u2019s National ID MUST be<\/li>\n<\/ol>\n

     <\/p>\n

      \n
    1. PRINCIPAL MEMBER’S DETAILS<\/strong><\/li>\n<\/ol>\n

      SURNAME: …………………………………….. OTHER NAMES: ………………………………………<\/p>\n

      NHIF NO. (Mandatory) ………………………… I.D NO.(Mandatory) ………………………………….<\/p>\n

      PERSONAL NO ………………………………… JOB GROUP ………………………………………….<\/p>\n

      DATE OF BIRTH (DD\/MM\/YYYY)……………….. GENDER (Male\/Female)……………………………..<\/p>\n

      MOBILE NO: …………………………………… EMAIL ADDRESS ………………………………………<\/p>\n

      EMPLOYER …………………………………….. STATION ……………………………………………..<\/p>\n

       <\/p>\n

        \n
      1. DEPENDANT(S)\u2019 DETAILS<\/strong><\/li>\n<\/ol>\n

        \u00a0<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
         <\/td>\n\u00a0<\/strong><\/p>\n

        NAME<\/strong><\/td>\n

        		DATE OF BIRTH<\/strong><\/td>\nGENDER<\/strong><\/td>\nPREFERRED<\/strong> MEDICAL<\/strong> FACILITY<\/strong><\/td>\n<\/tr>\n
        DD<\/strong><\/td>\nMM<\/strong><\/td>\nYR<\/strong><\/td>\nM\/F<\/strong><\/td>\nCODE<\/strong><\/td>\nNAME<\/strong><\/td>\n<\/tr>\n
        PRINCIPAL<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
        SPOUSE<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
        CHILD 1<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
        CHILD 2<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
        CHILD 3<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
        CHILD 4<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
        CHILD 5<\/strong><\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

         <\/p>\n

          \n
        1. REASON FOR CHANGE OF FACILITY<\/strong><\/li>\n<\/ol>\n

          \u00a0<\/strong><\/p>\n

          Tick as applicable:<\/p>\n

           <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
          01<\/td>\nTransferred to a new workstation<\/td>\n <\/td>\n<\/tr>\n
          02<\/td>\nPromotion<\/td>\n <\/td>\n<\/tr>\n
          03<\/td>\nUnavailability of services for 24 hours<\/td>\n <\/td>\n<\/tr>\n
          04<\/td>\nAsked to buy prescribed drugs<\/td>\n <\/td>\n<\/tr>\n
          05<\/td>\nUnavailability of dental services<\/td>\n <\/td>\n<\/tr>\n
          06<\/td>\nUnavailability of optical services<\/td>\n <\/td>\n<\/tr>\n
          07<\/td>\nLack of specialized services<\/td>\n <\/td>\n<\/tr>\n
          08<\/td>\nLack of laboratory services<\/td>\n <\/td>\n<\/tr>\n
          09<\/td>\nBad attitude from clinic staff<\/td>\n <\/td>\n<\/tr>\n
          10<\/td>\nCurrent facility stopped offering services<\/td>\n <\/td>\n<\/tr>\n
          11<\/td>\nOther (Specify)<\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

           <\/p>\n

           <\/p>\n

            \n
          1. CERTIFICATION<\/strong><\/li>\n<\/ol>\n

            \u00a0<\/strong><\/p>\n

            I certify that the information provided is correct to the best of my knowledge.<\/p>\n

             <\/p>\n

            Name of Employee………………………………Signature……………………….Date………………..<\/p>\n

             <\/p>\n

              \n
            1. FOR OFFICIAL USE<\/strong><\/li>\n<\/ol>\n

              \u00a0<\/strong><\/p>\n

              RECEIVED BY………………………………….Signature……………………….Date…………………..<\/p>\n

               <\/p>\n

              UPDATED BY……………………………………Signature……………………….Date………………….<\/p>\n

               <\/p>\n

              APPROVED BY…………………………………Signature……………………….Date………………….<\/p>\n","protected":false},"excerpt":{"rendered":"

              NHIF change of facility, hospital form APPENDIX3 NHIF 38 ISSUE No. 2 NATIONAL HOSPITAL INSURANCE FUND P .O. BOX 30443 – 00100 NAIROBI, KENYA. E-Mail: info@nhif.or.ke Website: www.nhif.or.ke CHOICE OF OUTPATIENT MEDICAL FACILITY FORM Guidelines: \u00a0 Principal Members are required to forward a duly completed form to the nearest NHIF To select a medical facility, […]<\/p>\n","protected":false},"author":18389,"featured_media":80757,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"tdm_status":"","tdm_grid_status":"","footnotes":""},"categories":[274],"tags":[],"class_list":["post-52910","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-nutrition-tips"],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/posts\/52910","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/users\/18389"}],"replies":[{"embeddable":true,"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/comments?post=52910"}],"version-history":[{"count":0,"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/posts\/52910\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/media\/80757"}],"wp:attachment":[{"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/media?parent=52910"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/categories?post=52910"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/newsblaze.co.ke\/wp-json\/wp\/v2\/tags?post=52910"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}