Self-Pay Patients
Forms
Patient Safety
Speak to Me
100

I need an EKG

What is inform the patient they will need to pay for the EKG

100

First step when a patient brings a form

What is scan the incomplete form in the patient's chart

100

Must do this at every patient encounter

What is ask for the patient's name and date of birth

100

The amount of time I need to call out

What is 2 hours prior to the start of the shift

200

The provider ordered a QFT

What is I will have a PPD. The provider needs to change the order.

200

Directions for a patient with a form

What is the form needs to be scanned into the chart

200

Must do this before collecting specimen

What is confirming the patient's full name and date of birth

200

Labor Day

What is you can labor at home; do not come in

300

The provider ordered 3 vaccines; I will pay this much

What is $75; $25 for the administration of each vaccine

300

Number of days for form completion

What is 7-10 days

300

Cough, sneezing, fever, rash

What is isolate the patient

300

Workplace environment

Respectful, professional, free of bullying

400

Select this coverage for labwork

What is self-pay

400

Sending completed forms via personal email

What is this is not standard practice; forms can be faxed.

400

Medical equipment and patient safety

What is cleaning the equipment between patient use and the end of the shift.

400

Medtrainer courses

What is please complete before they are due or past due

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