Health Partners Hospital Admission Discharge Form
This form is used by Health Partners to document the admission and discharge details of a patient in a hospital. It includes patient information, hospital details, and provider information. It is crucial for maintaining accurate records and ensuring proper care of patients.
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How do I fill this out?
To fill out this form, you need to provide details about the patient, hospital, and provider. Ensure that all required fields are accurately completed to avoid delays. This section will guide you through the necessary steps.
How to fill out the Health Partners Hospital Admission Discharge Form?
1
Complete the sender/caller information including your name and phone number.
2
Fill out the patient's information such as name, ID number, and date of birth.
3
Provide admission details including admission date, discharge date, and disposition.
4
Include provider information with facility name, address, and physician details.
5
Ensure all sections are thoroughly filled and fax the completed form to (952) 853-8705.
Who needs the Health Partners Hospital Admission Discharge Form?
1
Hospitals need this form to document patient admissions and discharges.
2
Healthcare providers use this form to ensure accurate patient records.
3
Insurance companies may require this form for processing claims.
4
Nursing homes use this form for transferring patients.
5
Patients may need this form to keep personal medical records.
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What are the instructions for submitting this form?
Fax the completed form to (952) 853-8705. Ensure all fields are accurately filled out and include any necessary attachments like admission H&P information. Check with your facility's guidelines for any additional submission requirements. Advice: Double-check the form for completeness and accuracy before submission to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
Keep the form updated annually and ensure it reflects the latest procedural information and codes as prescribed by Health Partners.
What is the purpose of this form?
The primary purpose of this form is to document the admission and discharge details of patients within the Health Partners network. It collects essential information including patient details, hospital and provider information, and critical dates that ensure accurate and timely communication between all involved parties. Properly filling out this form ensures that the patient's healthcare journey is well-documented and assists in seamless transitions between different stages of care.
Tell me about this form and its components and fields line-by-line.
- 1. Sender/Caller Information: Includes fields for the sender's name, phone number, and fax number.
- 2. Patient Information: Captures the patient's name, member ID, date of birth, and gender.
- 3. Admission Information: Documents admission and discharge dates, disposition, admission source, and type.
- 4. Provider Information: Contains facility name, address, phone numbers, tax ID, and physician details.
What happens if I fail to submit this form?
Failure to submit this form can lead to delays in patient care and record-keeping. It may also result in issues with insurance claims and patient transfers.
- Delayed Patient Care: Without this form, there may be delays in the administration of necessary treatments and services.
- Inaccurate Records: Failure to submit can lead to incomplete patient records, affecting the quality of care.
- Insurance Issues: Insurance companies may require this form for claims processing, and failure to submit it can result in claim denials or delays.
How do I know when to use this form?
- 1. Patient Admission: Complete this form at the time of patient admission to document all relevant details.
- 2. Patient Discharge: Fill out the form during patient discharge to ensure all discharge details are recorded accurately.
- 3. Transfers: Use this form when transferring a patient to another facility or department.
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