Collecting patient information is a big part of healthcare coordination.
By American Academy of Family Physicians
Medical forms are an important part of your patient records. They help your healthcare provider understand your health concerns, family health history, manage billing, and protect your privacy. It is important that you provide accurate information at your first visit to help your doctor make the best decisions for your plan of care.
Many practices will ask patients to update their information each year. If you are unsure why you need to provide certain information or sign a particular form, ask a member of the doctor’s office staff for help.
As technology advances, the practice may request the “forms” be completed and signed electronically before your visit. A second review typically occurs at the time of visit, along with a request for you to provide an “electronic signature” of your visit.
New patients may be asked to arrive 15-30 minutes early to complete forms if not completed prior to the visit. You will be asked to provide a photo ID (driver’s license) and current insurance card. The office will scan the cards into the electronic medical record. In addition, most offices take your picture to help staff identify you.
The day before your visit, prepare a list of current medications, questions about health concerns, and known family health-related history. Include health conditions such as diabetes, heart disease, glaucoma, cancer, substance abuse, and mental health history.
All of the forms you complete are important, however, every office is unique and may require different forms at your first visit.
The following are types of forms you may be asked to complete on your first doctor’s visit and update periodically:
Intake
The Intake Form may combine some of the clauses and purposes of other forms listed. The form verifies your name, address, phone, closest relative/emergency contact information, employer information, and other demographics. It also asks if your condition was due to an injury or accident, or if you have hired a lawyer and are part of a pending lawsuit. This information is necessary so the office can properly bill for services.
Patient’s Rights & Responsibilities
A Patient’s Rights and Responsibilities form details your right as a patient to considerate, dignified, respectful and non-discriminatory care from your providers and healthcare staff regardless of age, race, religion, nationality, legal status, financial status, type of insurance, diagnosis, sexual orientation, gender identity or expression.
Patient Health History
The Patient Health History form advises your physician and other members of the care team about your known health conditions. These conditions may include chronic illnesses such as diabetes, asthma, COPD, high cholesterol and high blood pressure. Depending on your age, various information about preventive care is also gathered, such as dates of immunizations, mammograms and colonoscopies.
The form will request a list of current medications; details about smoking, alcohol use and illegal drug history; list of medical conditions and names of medical providers providing care and treatment. Many providers in the same network share information so that they can better coordinate your care.
Family/Medical History
A Family Medical History form contains a record of health information about you and your close relatives. It may ask questions such as: How old are you? Do you or does anyone in your family have a history of chronic health problems such as heart disease, diabetes, kidney disease, bleeding disorder, or lung disease? Do you or does anyone in your family have a history of high blood pressure, high cholesterol or asthma?
This information can help the provider discuss preventive methods that may reduce the risk of developing health problems and better treat conditions if they do develop.
Consent to Treat
Consent to Treatment forms are to ensure that you are fully aware and accepting of a particular treatment or procedure. Parents or legal guardians will be required to give consent for minors.
Sometimes you will be asked to leave a credit card on file in addition to the consent to treatment.
HIPPA (Health Insurance (Portability and Accountability Act)
A HIPAA Privacy Notice describes how a provider may use and disclose your protected health information to carry out treatment, payment, or other healthcare operations and for other purposes that are permitted or required by law. It also describes your right to access and control your protected health information.
A HIPAA Authorization Form is a document that allows an appointed person or party to share specific health information with another person or group. Your appointed person can be a doctor, hospital, healthcare provider, family member or attorney.
Financial Responsibility
You are required to sign a Patient Financial Responsibility form. It means you agree to pay the balance due for all services rendered that are not covered by insurance. This includes co-pays, deductibles and any service determined to be “not payable” by their health plan. By signing this form, you accept financial responsibility for the complete charge and agree to pay the costs of all services not paid by insurance. If you are uninsured, you agree to pay for the medical services rendered at the time of service.
The more information you provide to your doctor or healthcare team, the more likely your plan of care will meet your needs. Be prepared.
