Provider Orders and Instructions Form - HCCIntelligence™ Premier Resource 2024-Premier Resource: Provider Orders and Instructions Form

Premier Resource: Provider Orders and Instructions Form - 2024

Pdf Summary

This document is a provider orders/instructions form that includes information about the patient, labs, medical equipment, important information, medication/other instructions, additional tests ordered, and the provider. <br /><br />Under the patient information section, the form asks for the patient's name, birth date, and gender. The next section is about labs, where the patient can select whether they require any specific lab tests such as blood or urinalysis. There is also an option to select "None" if no labs are needed. The form states that the results of the tests will be provided within 1-3 days. <br /><br />The next section is about medical equipment that may be required for home care, hospice, or community resources. Patients can select "None" if they do not require any medical equipment. <br /><br />The form also provides important information such as the approximate date of the patient's next appointment. It mentions that the patient will be contacted 1-2 days prior to the appointment with the specific date and time. The office hours are not specified and there are instructions to call the main office number for medical problems, questions, or prescription refills. For after-hours problems, patients are instructed to call the main office number to connect with the answering service. <br /><br />The medication/other instructions section gives patients the option to continue with the same medications or see changes below. <br /><br />The provider section includes information about the medical care provided by the provider. <br /><br />Lastly, there is a section for additional tests that may be ordered, such as x-ray, MRI, CT scan, or ultrasound. The patient can select if any of these tests are required and specify the location where the tests should be done. The form also includes spaces for the provider's signature and date. The document includes two practice names and addresses, along with phone numbers and email addresses. The document states that it was developed by the Home Centered Care Institute.

Keywords

provider orders

instructions form

patient information

labs

medical equipment

important information

medication instructions

additional tests

provider

Home Centered Care Institute