Get To Be Completed By Reception / Nurse - Nextcare

Completing the To Be Completed By Reception / Nurse - Nextcare form can ensure accurate patient information is recorded efficiently. This guide will provide clear, step-by-step instructions to assist you in filling out each section of the form correctly.

Follow the steps to accurately complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your designated editor.
2. Begin with the first section, 'Provider Name'. Enter the name of the healthcare provider clearly in the provided space.
3. In the 'Insurance Co' field, input the name of the patient's insurance company.
4. Fill in the 'TPA Name' section with the name of the Third Party Administrator, if applicable.
5. Locate the 'Patient file No' field and enter the unique identifier for the patient's file. Then, select the 'Plan Type' relevant to the patient.
6. Record the 'Date of visit' by entering the day, month, and year, indicating whether it is a new visit or a follow-up/refill.
7. Proceed to the section labeled 'To be completed by Attending Dentist'. Indicate the 'Duration of illness' followed by the 'Chief Complaint & Main Symptoms' detailing the patient’s primary concerns.
8. Input the 'Diagnosis' as well as the principal and additional diagnosis codes as required.
9. In the 'Other Conditions Diagnosis' section, provide details of any other relevant conditions.
10. Check the appropriate boxes that apply to the patient's condition, such as 'RTA', 'Work Related', etc.
11. Specify recommended investigations and procedures, including the tooth number, service descriptions, quantities, and cost in the respective fields.
12. Complete the certification statement by ensuring all information is correct and signing in the designated areas for the physician and other required staff.
13. After completing the form, save any changes, and consider downloading, printing, or sharing it as needed.

Complete your document online to ensure efficient processing and accurate record-keeping.