Scheduling & Check in
Pre-Registration/Registration
Privacy & Compliance
Insurance/Collections
Who is the Guarantor
100

This is the process patients complete when they arrive for an appointment.

What is check-in?

100

This is the process of confirming a patient's name, date of birth, address, phone number, and insurance information.

What is registration?

100

This may be signed to allow treatment to be provided

What is the Consent to Treat?

100

This may be signed to allow treatment to be provided.

What is the Consent to Treat?

100

This individual may not be the patient or the insurance subscriber but is legally responsible for any remaining balance on the account.

Who is the Guarantor

200

This may be needed when a patient cannot attend their original appointment time.

What is rescheduling?

200

This identifier is commonly used with the patient’s full name to help confirm identity.

What is date of birth?

200

This form explains how patient health information may be used and disclosed.

What is Notice of Privacy Practice?

200

This confirms whether the patient’s coverage is active on the date of service.

What is eligibility verification?

200

A 22-year-old patient is still covered under a parent's insurance but lives independently and pays their own bills. 

Who is the patient?

300

This identifier is commonly used with the patient’s full name to help confirm identity.

What is date of birth?

300

Guarantor

Who is ultimately responsible for the bill?

300

This may be needed when someone other than the patient is authorized to receive information.

What is release of information or authorization to disclose information?

300

Deductible

What is the amount set by the insurance company that a member must pay before they start paying any benefits.

300

A 16-year-old patient is covered by their father's insurance, lives with their mother, and their parents are divorced. The father is the insurance subscriber, but the divorce decree states the mother is financially responsible for medical expenses.

Who is the parent that accompanies the child to the appointment?

400

The unique number assigned to each patient, used to link individual episodes of care to one patient within the system.

What is an MRN#?

400

This should be reviewed even if the patient says “nothing has changed.”

What is demographic information?

400

Durable Power of Attorney for Healthcare, and Living Will

What are the the two types of advance directives?

400

This may be required before certain visits, tests, or procedures.

What is authorization?

400

A 17-year-old patient arrives alone for an appointment and presents their own insurance card.

Parent/Legal Guardian

500

This is why patient identity must be verified at every interaction.

What is patient safety?

500

This could delay care if it is missing, expired, or does not match the scheduled service.

What is an order or referral?

500

This should be reported if patient information is sent to the wrong person or viewed inappropriately.

What is a breach?

500

This can occur when insurance information is entered incorrectly or not verified.

What is a claim denial or billing delay?

500

This individual may not be the patient or the insurance subscriber but is legally responsible for any remaining balance on the account.

Who is the Guarantor?

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