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Form AI-346, Gastos Médicos Mayores Informe Médico, page 1
Complex · 66/100Form Complexity Index

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What this form asks for

The AI fills all of it, from your answers or your documents.

Form AI-346, known as the 'Informe Médico' from AXA Seguros, is a comprehensive medical report that must be completed by a treating physician to support a major medical expense insurance claim. It details the patient's medical history, diagnosis, treatment plan, and prognosis, which is essential for AXA to assess the claim's validity and coverage. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
Fillable fields187
Pages5
Sections25
Questions that depend on earlier answers25
Form Complexity IndexComplex, 66/100

The AI checks your answers before you download

13 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Age and Date of Birth Consistency

This check verifies that the patient's stated 'Edad' (Age) is consistent with the provided 'Fecha de nacimiento' (Date of Birth). This validation prevents data entry errors and ensures the patient's demographic data is accurate for risk assessment and policy verification. If the values do not match, the form submission will be flagged for manual review to correct the discrepancy.

Chronological Order of Medical Dates

Verifies that the 'Fecha de diagnóstico' (Diagnosis Date) is on or after the 'Fecha de padecimiento' (Condition Onset Date). This ensures a logical timeline of the medical event, which is crucial for determining coverage eligibility and understanding the condition's progression. A failure indicates a likely data entry error that must be corrected before the claim can be processed.

Maternity Claim Gender Verification

Confirms that if 'Maternidad' (Maternity) is selected as the 'Motivo de la atención médica' (Reason for Care), the patient's 'Sexo' (Sex) must be 'Femenino' (Female). This is a fundamental logical check to prevent invalid claims related to maternity. Submissions failing this check will be rejected as they represent a logical impossibility.

Obstetric History Consistency

Validates that the sum of 'Partos' (Births), 'Abortos' (Abortions), and 'Cesáreas' (C-sections) is less than or equal to the total number of 'Gestación' (Pregnancies). This check ensures the internal consistency and plausibility of the patient's obstetric history. An inconsistency suggests an error in reporting that could affect medical assessment and must be clarified.

Hospitalization Period Validation

Ensures the 'Fecha de alta' (Discharge Date) is on or after the 'Fecha de hospitalización' (Admission Date). This validation confirms a valid and logical duration of stay for processing hospitalization benefits. If the discharge date is before the admission date, the form will be rejected for correction of this critical error.

Conditional Requirement for Cancer Staging

This check mandates that if the diagnosis is marked as 'Es cáncer: Sí' (Is Cancer: Yes), the 'Escala TNM' (TNM Stage) field must be completed. The TNM stage is essential for determining the severity, prognosis, and appropriate treatment protocol, directly impacting claim evaluation. A missing TNM stage will halt processing until the information is provided.

And 7 more checks
  • Physician's RFC Format Validation
  • Incapacity Period Chronology
  • Completeness of Patient's Full Name
  • Conditional Requirement for Pathological History Date
  • Blood Pressure Format Validation
  • Conditional Requirement for Referral Details
  • Completeness of Medication Entry

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How to Fill Out AI-346 Online for Free in 2026

What the AI walks you through.

  1. Navigate to Instafill.ai and upload or select the AXA Form AI-346, Informe Médico.
  2. The treating physician uses the AI assistant to accurately input the patient's general information, medical history, and vital signs.
  3. Detail the diagnosis, including the current condition, onset date, cause, and relevant ICD codes.
  4. Describe the proposed or administered treatment, including medications, surgical procedures, hospitalization dates, and any required therapies.
  5. Enter the details of all attending physicians, including their specialty, professional license numbers, and signatures.
  6. The insured patient reviews the document and signs the authorization sections for the use and transfer of personal and sensitive data.
  7. Review all the information for completeness and accuracy before securely downloading or submitting the finished document to AXA Seguros.

Common Mistakes in Completing AI-346

The ones the AI is built to catch.

Incomplete or Illegible Physician Information
Doctors or administrative staff often forget to fill in all required fields, such as the professional license number (Cédula Profesional), specialty license, or RFC (tax ID). Illegible handwriting for names and contact details is also common. This can invalidate the report, as the insurer cannot verify the credentials of the treating physician, leading to significant delays or outright rejection of the claim until a corrected form is submitted.
Vague Medical History Descriptions
In the 'Antecedentes' sections, the form asks for specific details like frequency, quantity, and start dates (e.g., for smoking or alcohol use). Users often provide vague answers like 'socially' or 'occasionally' instead of the required specifics. This lack of detail can lead the insurer to request more information, delaying the claim's processing while they assess risk factors.
Confusing Onset Date with Diagnosis Date
The form distinguishes between 'Fecha de padecimiento' (date the condition started) and 'Fecha de diagnóstico' (date it was formally diagnosed). Applicants frequently use these dates interchangeably or leave one blank. This is a critical error for the insurer, as it affects the determination of pre-existing conditions and can lead to claim disputes or denial if the timeline is unclear.
Omitting Mandatory Diagnostic Details
When describing a diagnosis, crucial specifics like the ICD code, whether a condition is unilateral/bilateral, or the TNM cancer staging are often missed. For example, checking 'Sí' for cancer but leaving the 'Escala TNM' field blank provides incomplete information. This forces the insurance company to halt processing and request a more detailed report from the physician, delaying approvals for treatment.
Insufficient Justification for Tests and Treatments
The form requires a description of lab/imaging studies *with their interpretation* and a detailed breakdown of prescribed medications (dosage, frequency, duration). A common mistake is to list the names of tests without their results or to provide an incomplete medication schedule. Without this justification, the insurer may deem a procedure or medication as not medically necessary, potentially refusing coverage.
Ignoring Basic Form-Filling Instructions
The instructions explicitly state to use legible block letters, black ink, and to submit an original document without any cross-outs or alterations ('tachaduras y/o enmendaduras'). Many submissions are rejected because they are filled in blue ink, have messy handwriting, or contain corrected mistakes. This forces the applicant to have the entire multi-page form filled out again by the doctor, causing significant delays.
Missing Patient Signature on Authorization Sections
The final page contains crucial authorization sections that must be completed and signed by the insured, not the doctor. Patients often overlook this part, assuming the entire form is for the physician. Without these signatures authorizing the use and transfer of sensitive personal data, the insurer is legally unable to process the claim, bringing the entire procedure to a halt.
Incomplete Accident or Injury Description
For claims related to an accident, the form requires a detailed description of the 'tiempo, modo y lugar' (time, manner, and place) of the incident. Submissions often lack this detail, providing only a brief summary like 'fell at home'. This ambiguity can delay the claim as the insurer investigates to rule out policy exclusions and confirm the circumstances of the injury.
Leaving Conditional Fields Blank
Throughout the form, there are questions where checking 'Sí' (Yes) requires a mandatory explanation in an adjacent field (e.g., 'Se presentaron complicaciones: Sí / No. Describa...'). A frequent error is to check 'Sí' but leave the description box empty. This creates an incomplete record, forcing the insurer to follow up for the missing information and delaying the claim.
Using a Non-Fillable PDF without Proper Tools
This form is a flat, non-fillable PDF, which leads to manual filling and increases the likelihood of all the previously mentioned errors like illegible handwriting and mistakes requiring a full restart. Trying to fill it digitally without the right software can result in misaligned text and a unprofessional appearance. AI-powered tools like Instafill.ai can convert such documents into smart, fillable forms, validating data as it's entered to prevent errors and ensure a clean, professional submission.

Frequently Asked Questions About AI-346

 

Is it really free for 7 days?
Yes. You pay $0 today. Cancel before Nov 8 and you are never charged. Keep it, and it is $19.99 a month for 5 fills of your AI-346.
Can I fill other forms too?
This plan is for your AI-346: your own AI agent fills it as often as 5 times a month. To fill other forms and upload your own, choose a Professional plan from your account.
How do I cancel?
From your account, in two clicks, any time. No email, no call.
How does the AI fill out AI-346?
You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of AI-346, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is AI-346 to fill out?
AI-346 has a Form Complexity Index of 66 out of 100, in the complex tier: 187 fillable fields across 5 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the purpose of the AXA 'Informe Médico' form?
This form is used by your physician to provide AXA Seguros with detailed medical information about your diagnosis and treatment. It is essential for processing claims, authorizing procedures, or requesting reimbursements under your Major Medical Expenses policy.
Who is responsible for filling out this form?
Your treating physician and any consulting specialists must complete all the medical sections of the form. The insured patient, or their parent/guardian, is responsible for filling out and signing the authorization section at the end.
How often do I need to submit a new 'Informe Médico'?
You must submit an updated form every 6 months. A new form is also required if you change your treating physician, or if your diagnosis or treatment plan changes.
What happens if more than one doctor is treating me?
Each treating physician and consulting specialist involved in your care must fill out and sign their own separate 'Informe Médico' form. This ensures all aspects of your treatment are properly documented for the insurance claim.
What should I do if I make a mistake while filling out the form?
The form will be invalid if it has any cross-outs, corrections, or alterations. You must start over with a new, clean form to ensure it is accepted by AXA.
Why do I need to sign the authorization sections at the end of the form?
Your signature authorizes AXA to use and share your sensitive medical data with specialists and providers as needed to manage your insurance benefits. This is necessary for them to coordinate care, process claims, or obtain a second opinion on your behalf.
What information does my doctor need to provide in the 'Padecimiento actual' section?
In this section, your doctor must describe your current condition, including signs and symptoms, the date the condition started, the date of diagnosis, and the cause or origin of the illness or injury.
What if my treatment involves more than 10 medications?
The form has space to list up to 10 medications. If your treatment plan includes more, your physician should fill out an additional 'Informe Médico' form to list the remaining prescriptions.
Does my doctor need to attach my lab results or other studies to this form?
Yes, your doctor should describe the relevant findings from lab and imaging studies in the designated section. It is also highly recommended to attach copies of the original reports to support the claim and prevent delays.
Can I use an AI tool to help fill out this form?
Yes, services like Instafill.ai use AI to accurately auto-fill patient information fields, saving you and your doctor's office time. However, all medical details must be entered and verified by the treating physician.
The PDF form I have is not fillable. How can I complete it on a computer?
You can use a service like Instafill.ai to make any non-fillable PDF interactive. Simply upload the document, and the platform will convert it into a fillable form that you can complete online.
How can I use Instafill.ai to fill this form?
Upload the 'Informe Médico' PDF to the Instafill.ai platform, which will identify all the fields. You can then type in the information or use the auto-fill feature with your saved data, then download the completed PDF for printing and signing.
What is the 'Código ICD' that the form asks for?
The ICD code is a standard diagnostic code from the International Classification of Diseases. Your doctor will provide this code, which specifically identifies your medical condition for billing and records.
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