Get Ahmc Surgery Scheduling Request Form 2010-2025

Filling out the AHMC Surgery Scheduling Request Form online can streamline the scheduling process for surgical procedures. This guide provides clear, step-by-step instructions on how to complete each section of the form, ensuring an efficient and accurate submission.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the person completing the form in the 'Completed by' section. Ensure accuracy as this will be important for follow-up communications.
3. Provide the office number or direct line in the designated field. This is crucial for any necessary contact regarding the scheduling.
4. Fill in the date on which the form is completed. This helps maintain an accurate timeline for the scheduling process.
5. Input the patient’s Social Security Number (SSN) and their legal name, including last name, first name, and middle initial.
6. List the patient’s daytime and evening phone numbers to ensure proper communication regarding the surgery scheduling.
7. Indicate any known allergies the patient may have, and provide details about their insurance, including the authorization number for the surgery if already obtained.
8. Complete the fields for the patient’s sex, age, and date of birth, which are necessary for identification and medical history.
9. Enter the surgeon’s name (last and first) as well as any assistants or proctors that will be involved in the procedure.
10. Describe the patient’s diagnosis and the procedure or surgery planned, ensuring any relevant details are included.
11. Specify the patient status, selecting from options such as out-patient or in-patient as applicable.
12. Choose the type of anesthesia required for the surgery and indicate any specific preferences in the provided field.
13. Provide the anticipated date and time for the surgery, along with the estimated length of the procedure.
14. Note any pre-admission screening appointments, including the primary care physician and the medical group involved.
15. List the lab tests to be performed and any medical or cardiac clearance details necessary prior to the procedure.
16. Indicate if there are any abnormal lab results that need to be communicated, including initials of the responsible party.
17. Include any special requests or notes regarding the patient’s needs, such as communication methods or facility requirements.
18. After thoroughly reviewing the form for completeness and accuracy, save changes, download, print, or share the form as needed.

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