Msi Renewal Form PDF Details

The process of renewing a health card in Nova Scotia requires meticulous attention to detail, specifically via the MSI Renewal Form. This critical document, a key to ensuring continuous access to healthcare services, mandates the completion and signature of the applicant or, for minors under 16, a parent or guardian. It seeks various pieces of information, including personal details like name, health card number, date of birth, phone numbers, and gender, as well as mailing and home addresses. Significantly, it inquires about any changes in residency, underscoring the requirement for the applicant to be a bona fide resident of Nova Scotia—defined as someone who lives in the province and is physically present for no less than 183 days each calendar year. Furthermore, the form serves as an authorization for health service providers to release necessary information to Medical Services Insurance (MSI) for the purposes of claims payment and auditing. Of notable importance is the section on organ and tissue donation, reflecting recent adjustments to Nova Scotia’s legislation. Applicants 19 or older are presumed to consent to organ and tissue donation upon death unless they expressly opt out. This change aims to increase the donor pool and save lives, making it imperative for applicants to understand their options and communicate their decisions to family members. The document also provides relevant contacts and information for individuals seeking to learn more about organ and tissue donation, solidifying its role as not just an administrative formality but a pivotal component of Nova Scotia’s healthcare and organ donation ecosystem.

QuestionAnswer
Form NameMsi Renewal Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmsi card renewal, msi renewal, ns health card renewal, how to renew msi health card

Form Preview Example

To prevent delays in the processing of your request this section of the form must be signed in the space provided and returned to MSI. For children under the age of 16 a parent/guardian must sign.

HEALTH CARD

RENEWAL

First Name

 

Middle Name

 

 

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please print your health card number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

neatly in the boxes provided

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth Day Month Year

Gender

 

 

Daytime Phone Number

Other Phone Number

 

 

 

 

 

Female

 

 

Male (

)

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

City

 

Province

 

Postal Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Address (if different)

 

 

 

 

 

 

 

 

Community

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Has your address recently changed?

 

 

 

 

Yes

 

 

No If so, is this a complete family move?

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

I certify that I am a resident of Nova Scotia. A resident is a person who makes his/her home and is ordinarily present (physically present for at least 183 days calendar days per year) in Nova Scotia. I authorize any health service provider paid by Medical Services Insurance (MSI) to release any information requested by MSI for claims payment and audit.

Signature Date

Your organ and tissue donation decision

It is your choice. You can indicate a donation decision below or choose not to register one. You can change a previous decision at any time.

If you are 19 or older and eligible, you will be seen as agreeing to be an organ and tissue donor after your death, unless you register a decision to opt out of donation. This will be confirmed with your family at the time of your death. Learn more about who is eligible at www.novascotia.ca/organtissuedonation or by calling MSI at 1-800-563-8880 or 902-496-7008 in HRM.

Do you want to register a donation decision now?

Completely fill in the circle to mark your choice:

Yes, I want to be a donor and donate all organs and tissues (donor 1)

Yes, I want to be a donor and ONLY donate the following organs and tissues (donor 2):

Organs:

 

Lungs

 

Heart

 

Liver

 

Kidneys

 

Pancreas

 

Small Bowel

 

 

 

 

 

 

 

 

 

 

 

Tissues:

 

Skin

 

Vein

 

Eyes

 

Bone & Related Structures

 

Heart Valves/Pericardium

No, I don’t want to be a donor (opt out)

Talk about it

Talk with your family, friends and those closest to you to make sure they know your donation decision.

Find out more

Learn more about your organ and tissue donation choices, and recent changes to Nova Scotia’s organ and tissue donation legislation at www.novascotia.ca/organtissuedonation. Learn about organ and tissue donation at www.nshealth.ca/legacy-life or by calling 1-877-841-3929 for organ donation and 1-800-314-6515 for tissue donation.

Please fax to MSI Resident Services at 902-481-3160

Or Mail to: MSI Resident Services, PO Box 500, Halifax, NS, B3J 2S1

Phone 902-496-7008 (1-800-563-8880)

Please note this form cannot be submitted online.

How to Edit Msi Renewal Form Online for Free

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Step 2: This editor offers the opportunity to change your PDF form in a variety of ways. Improve it with any text, adjust existing content, and add a signature - all close at hand!

For you to fill out this PDF document, ensure you type in the right information in every single blank:

1. It's essential to complete the msi health card renewal properly, hence be attentive while filling out the parts comprising all these blank fields:

Completing part 1 in msi renewal form online

2. When this section is completed, it's time to put in the necessary details in Your organ and tissue donation, Kidneys Pancreas Bone Related, Small Bowel Heart ValvesPericardium, Lungs Skin, Heart Vein, Liver Eyes, Please fax to MSI Resident, Or Mail to MSI Resident Services, Phone, and Please note this form cannot be so you can move forward further.

Filling out part 2 in msi renewal form online

It is easy to get it wrong when filling out your Phone, thus be sure you take a second look prior to when you send it in.

Step 3: After taking another look at your fields and details, click "Done" and you're all set! Sign up with us right now and instantly access msi health card renewal, ready for downloading. All changes you make are preserved , which enables you to customize the form at a later time when necessary. FormsPal is dedicated to the privacy of all our users; we always make sure that all personal information put into our system is protected.

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