What Form
A legal document signed by a minor's legal guardian, granting Hoag permission to provide medical care for their child.
What is Consent to Treat a Minor
Authorization to Share
What is Hoag can share your health information with people you choose.
Doc type: Authorization to release protected Health information
What is Authorization to release medical records
Every form should have this on the bottom right corner before you scan it into the patients chart
What is a Patient Label?
I haven't been able to verify a patient's insurance prior to them being seen by the provider. The patient will need to complete this form.
What is a Financial Responsibility Acknowledgement Form
Informs patients of a database that is publicly accessible and tracks financial relationships between providers and drug companies.
What is Notice of Payments
Grandma can bring her grandchild to an appointment and make medical decisions at his appointment, why?
What is grandma is on the Authorization 3rd party to consent treatment minor form.
Once in a lifetime
What is One and done
I would like to have my visits with my provider recorded.
What is Consent to AI Scribe recording form.
Jessica wants her specialist to have copies of all of her labs that she has completed at her providers office. What does Jessica need to fill out?
What is an Authorization to Release Medical Records form
This form may also have an estimate included for the patient's visit.
What is a Cash Payment Agreement
Medicare Annual Well Visit Consent
Bonus--if you can list what the visit may include
What is gives Hoag/provider consent for an Annual Wellness Visit.
Bonus--Visit includes vital signs, medical history, review meds, counseling on healthy lifestyles, review age and gender appropriate screening kits.
A patient cannot be seen if they do not sign this form
What is the Conditions of Treatment and /or Consent to treat a minor
You notice that a patient has an expired Authorization to Share form in Epic. The spouse, who is on the Authorization form, calls to get results. What should you do?
What is give the spouse the information requested.
WHY---the consent is valid, until a new is filled out.
Jacob has decided that he does not want to have his visits recorded. What do you do?
What is--Add the Ai Scribe Consent form in his documents and ark as "patient refused"
Extra 100pts--What if Jacob already had a consent form on file?
Fill out Patient Opt-Out Request form and send to HIM for processing
Only patients who have Medicare Part B and are scheduled for this particular visit, needs to fill out this form.
What is an Annual Well visit consent
Cash Payment Agreement
What is payment is required at the time of service. Payment must be made today to receive the discount. This form should have an estimate to explain to the patient.
Doc Type: HIPAA Notice of Privacy
What is the Acknowledgement reciept of Notice of Privacy Practices (NPP)
I don't understand what Notice of Open Payments Database form is.
What is it informs patient there is a federal database that is available for them to look at. It is a public website where drug/medical companies report payment, transfers of value to doctors' offices and hospitals. It helps you make informed decisions about your healthcare.
How do you know if a form is expired or not
What is: Epic will tell you an expiration date.
Some forms have no expiration date and good forever.
Some forms tell you how long they are good for on the form(Auth to Release copies of medical records-- 1yr)
Patients acknowledge what is included in their visit and that they will be financially responsible for discussion/services provided on top of those services.
What is HMG Preventative Care.
Conditions of Treatment
What is this form gives Hoag consent to treat you, bill your insurance and contact you via email, text or phone.
I may use these types of forms in certain circumstance.
What is Ad Hoc
What is Authorization 3rd party consent treatment minor form
What two forms require HIM to process and scan into the patients chart?
What is: Patient Opt-Out Request for AI Scribe and Hoag's Health Information Exchange (HIE) Opt-Out form