DOWNTIME ? Entered into electronic record after downtime date time initials FAMILY HEALTH CARE DECISION ACT (FHCDA) CONSENT FORM 2 Patient Name Date of Birth Admission/Visit Date Medical Record Number.
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How to fill out the Infoclique online
Filling out the Infoclique form requires careful attention to detail, especially when it comes to health care decisions for individuals who lack capacity. This guide will walk you through each component of the form, ensuring you understand how to complete it accurately.
Follow the steps to fill out the Infoclique form effectively.
- Press the ‘Get Form’ button to access the Infoclique form and open it for editing.
- Complete the downtime section by entering the date, time, and your initials. This section confirms that the form is part of the electronic record after downtime.
- Fill in the patient’s name and date of birth accurately to identify the individual involved.
- Enter the admission or visit date along with the medical record number to provide context for patient care.
- Specify the site and financial number associated with the patient's health care services for proper billing and record-keeping.
- Identify the patient in the Patient ID area to ensure proper tracking within the health care system.
- Indicate the determination of incapacity by the attending physician. Complete the details regarding the patient’s capacity and document the cause and likelihood of regaining capacity.
- Notify the patient and the surrogate about the incapacity determination, ensuring to select the appropriate option regarding the patient's comprehension.
- Identify the surrogate who will be making decisions on behalf of the patient, following the priority list provided.
- Inform the selected surrogate about the situation, confirming their understanding that they will need to make health care decisions.
- Finally, have the attending physician sign and date the form, ensuring all required statements are completed.
- Once all sections are filled, save your changes, and choose to download, print, or share the completed Infoclique form as necessary.
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