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?
You gave a patient an opt out form for AI Scribe. What do you do with that form?
What is send completed form to HIM (Medical Records) for them to scan into the patient's chart?
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.
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.
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.
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
John is a new 35year old patient to Hoag. He is coming in for a physical with his provider. He has no insurance and will be paying cash for his visit. He also stated that he will be seeing a specialist and would like his records sent to that provider as well. What forms will John need to complete today?
What is
Conditions Treatment, Acknowledgement receipt of notice of privacy practices (NPP), Authorization to Share, Open Payments Database, Cash Payment Agreement, AI Scribe consent, HMG Preventative Care and Authorization to Release Medical Records.