Financial Screening Form
Pre-Reg and Insurance
Registration/Check-In
Call Routing
Scheduling
100

This status is used when a patient has applied but not presented proof of income

SMCHC - Proof of income required

100

This message is used when everything has been verified and no documents are required.

Pre-Reg

100

What documents are required for check-in?

CDF, FSF, HIPAA, Patient ID, Insurance Card

100

How often must a patient be seen to continue receiving a medication refill

Within 6 months
100

How long can new patient visits be?

15 or 20 min 

200

This document is used when you have exhausted asking for all types of proof of income and the patient has none.

POI Waiver

200

This message is used when everything is verified but zero documents are complete. 

Pre-Reg: CDF, FSF, HIPAA

200

Once a new patient has been fully checked in, what documents must be presented to the patient? (Add bonus question here for extra 200 points - what is included in the welcome packet?) 

Medical history and welcome packet 


200

This message pool is for behavioral health patients 

Tumwater MH Nurse Pool

200

Where can't new patients be scheduled?

Next to comprehensive appointments and not prior to lunch or the EOD 

300

Can you use a food stamp benefits statement as POI?

BONUS: Can EBT be used as income?

Yes ---- No

300

This insurance search term is used when looking for veterans insurance

Triwest

300

What insurances are Dr. Fuerst currently credentialed with?

Medicaid and Delta Dental

300

This message pool is for ortho patients

Lacey Dental Front Office Pool

300

Are well child checks comprehensive appointments?

No

400

A patient brings in POI - they received an average of 2500 every 2 weeks, what do we multiply 2500 by to receive their annual income? 

26

400

List the following insurance in the correct filing order

Molina Apple Health - Cascade Select - United Healthcare Medicare Advantage 

400

At what intervals after a patient's appointment time when a provider is running late should we check-in on patients

Every 15 minutes 
400
SCRIPTING:State the most proper script for when answering the phone

Good morning/afternoon/evening, thank you for calling Sea Mar, my name is _______, how may I help you?

400

What is the navigation to the clinic profiles for all sites? (Website and each button click)

Sharepoint > Central Services > Call Center > Clinic Profiles

1000

SCRIPTING: What is the first question we ask patients when they arrive to any clinic? 

Tell me the proper FSF script

How may we help you? 

“As a federally funded health center, we are required to anonymously report demographic information and income on all of our patients. This helps determine your eligibility for discounts on services at Sea Mar, including those not covered by your insurance and services provided by our contracted lab. We will require proof of income to begin providing a discount, would you like to apply today?

1000

List all the verification you must do during Pre-Registration

Name, DOB, PCP, Insurance, Time of Appt, Emergency Contact, Address, Phone, Homeless Status, Farmworker Status, MyChart Status, documents 

1000

What age can a patient check themselves in for family planning including birth control, pregnancy test, and mental health/substance use disorder? What about for sexually transmitted infections? (STI)

13, 14

1000

How many days left does a patient have for their first order of meloxicam? 

Meloxicam

Take 1 tablet my mouth twice daily for pain.  For back pain, DISP-60 tablet, R-0, E-Prescribe, Oral

Dispense: 60 Tablet

Refills: 1 Ordered

Pharmacy: Huy's Pharmacy

---Order Details---

Ordered on: 3/1/2026

Associated dX: Chronic Bilateral low back pain

Authorizing Provider: Joly Wu, PA-C

4 days left.  

1000

A patient arrives stating that they fell and have a booboo on their knee, they are not a patient at Sea Mar, what do you put in the appointment notes? What visit type?

Standby - Issue with Knee | Simple Visit