Get Direct Admit Form

Completing the Direct Admit Form online is a straightforward process that can streamline patient admissions. This guide offers detailed instructions to ensure that users can easily navigate each section of the form.

Follow the steps to successfully complete the Direct Admit Form online.

1. Click ‘Get Form’ button to obtain the Direct Admit Form and open it in your preferred document editor.
2. Begin with the call information section. Fill in the date and the time the call was received. Include the name of the primary care provider (PCP) and the case manager's information.
3. Next, move to the patient information section. Record the date of birth (DOB), patient name, and sex. Specify the age, and enter the medical record number (MRN) along with the patient's contact number.
4. In the presenting from section, choose the appropriate option that describes the source where the patient was referred from, such as 'Dr Office,' 'Home,' or 'Other.'
5. For the insurance section, document the policy or plan details and authorization information as required.
6. Proceed to the clinical information section. Here, note the attending physician, any intensivist applicable, and the referring physician’s contact number.
7. Fill in the diagnosis and select the type of bed requested, choosing from options like Med/Surg, Med Tele, Card Tele, Ortho, etc.
8. Indicate the type of admission needed (e.g., Full, Observation, Pre-Reg for Surgery) and any isolation needs, specifying if rehabilitation or hospice is required.
9. Provide details regarding the time booked and the room number if applicable. Confirm if a doctor-to-doctor report has been completed.
10. Complete the final sections by indicating if interqual criteria has been met, whether the information has been sent to prior authorization (PA), and whether the response has been charted.
11. After filling in all fields, ensure that your information is correct. Save any changes you have made, and download, print, or share the completed form as necessary.

Complete your Direct Admit Form online today to facilitate a timely admission process.