Get Fl Palms West Hospital Direct Admission Reservation Form 2018-2025

Filling out the FL Palms West Hospital Direct Admission Reservation Form online is a straightforward process that ensures timely patient admission. This guide provides detailed steps to help users complete the form accurately and efficiently.

Follow the steps to complete the admission reservation form online:

1. Press the ‘Get Form’ button to obtain the form and open it in your designated editor.
2. Enter the current date in the ‘Today’s Date’ field to reflect when the form is being filled out.
3. Provide the authorization number in the designated field. This number is crucial for processing the admission.
4. Specify the admission date by entering it in the corresponding field.
5. Indicate the type of admission by checking the appropriate box, which includes options such as Inpatient, Cardiac, Surgical, and others.
6. Fill in the patient’s last name in the ‘Patient Information’ section.
7. Complete the remaining sections under ‘Patient Information’ including first name, middle initial (if applicable), date of birth, social security number, and sex.
8. In the ‘Physician Information’ area, provide the admitting physician's contact details including the office phone number.
9. Under ‘Patient Insurance,’ fill out the insurance company name, address, and policy and group numbers, along with the primary care physician's name.
10. If applicable, complete the ‘Patient Secondary Insurance’ details in the respective section.
11. List all diagnosis(es) along with their corresponding code(s) in the designated spaces.
12. If applicable, indicate allergies or specify ‘No Known Drug Allergies’ (NKDA). In the ‘Additional Comments’ section, provide any relevant details.
13. Review all entries for accuracy and completeness before proceeding.
14. Finalize your form by saving your changes, and you may choose to download, print, or share the form as needed.

Start filling out the FL Palms West Hospital Direct Admission Reservation Form online today for a smooth admission process.