This Walkthrough is designed to take you through the steps of creating a new caregiver request.
*The Caregiver process can only be used if you have legal authority to act on behalf of the patient.
1) Navigate to the website that is pertaining to your request.
● If you are starting a new FMLA or Disability request, click Start a New Request ● If you have forms that need to be updated, click Fix My Form (You will need your confirmation number that was emailed to you when you finished your original request.) ● If you need an extension on your
current request, click Get Follow-up Form (To complete this process, you will need to have all forms given to you for follow up, and the confirmation number that was emailed to you when you finished your original request.)
2) Once you have clicked on Start a New Request, select the location that you received care and click the ‘Next’ button on the bottom right.
3) Once you have clicked on Start a New Request, select the location that you received care and click the ‘Next’ button on the bottom right.
4) Upload your forms here. Once they are uploaded, you will be able to click next to continue.
*Please note, the only formats we accept are PDF, PNG, JPEG, and HEIC, All forms must be combined into a single file, and they cannot exceed 20 MB.
5) Once you hit next, you will be given an option at the top to select if you are the Patient or the Caregiver You will select Caregiver. When you do this, the form will change, allowing you to put in your information as the Caregiver.
Please note: When uploading your documentation, it must be in a JPEG, PNG, or PDF format and 5 MB or less.
6) Once you have completed the Caregiver portion, scroll down and complete the Patient’s information. Note: All fields with a red asterisk must be filled out. Once you have
all required fields completed, please press next.
7) On the next page, please fill out:
● The Physician’s name
● The date the Patient was seen
● The Recipient Detail (the person who will receive the completed forms)
● The method of delivery
When you get to the Preferred Method of Delivery, if you select email, you will have the option of having the forms emailed to you, the patient, or the recipient.
Only one method can be selected.
8) On the next form, please upload a picture of the driver’s license or photo ID for the
Caregiver. Please remember, the photo must be in a JPEG or PNG and 5 MB or less.
9)PleasereadtheHIPAAstatements, checkall appropriateboxes, andsignbeforegoingtothenext section.
10)Once you confirm that all the fields are correct on the confirmation page, click next. The next page, you will be able to put in your payment information.
11) Once you pay, you will be emailed a confirmation for your records.
If you have any questions, please feel free to email healthforms-support@datavant.com
*When you get your confirmation email, save the confirmation number. You can use it to check status of your paperwork at any time by checking our status tracker located here: https://healthforms.datavant.com/status