Birth/Month: Cell Phone Number: Day: Year: English Spanish Other Responsible Party: (check here if same as above) Name/Last: First: Mailing Address: Ethnicity: Race: Male Female Work Telephone Number: Employer s Name: Preferred Language: Communication Needs Email Address: Middle: Name: Ext: SSN: City: Insurance Coverage Insurance #1 Name of Insurance Company: Policy Number Employer: Insurance # 2 Name of Insurance Company: Policy Number Employer: Insurance # 3 Name of Insurance.
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How to fill out the LA Willis-Knighton Health System PI3864 online
Filling out the LA Willis-Knighton Health System PI3864 form online can be a straightforward process. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to fill out the PI3864 form online.
- Click ‘Get Form’ button to access the form and open it in the online editor.
- Begin by entering the patient’s last name in the appropriate field, followed by their first name and middle name, if applicable.
- Provide the patient’s complete residence address including street address, city, state, and zip code.
- Fill in the social security number for the patient.
- Indicate the patient’s home telephone number, cell phone number, and date of birth, making sure to select the correct month, day, and year.
- Select the patient’s preferred language from the options provided, including English, Spanish, or Other.
- Identify the responsible party by checking the box if it is the same as the patient. If not, enter their last name, first name, and mailing address.
- Complete the sections regarding the responsible party’s ethnicity, race, marital status, and contact details.
- List the patient’s insurance coverage details including the names of insurance companies, policy numbers, and employer information.
- Indicate any communication needs and preferred pharmacies for the patient.
- In case of an emergency, list the name and contact details of a person who should be notified.
- Review the filled form for accuracy, and then save changes, download, print, or share the document as required.
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Who is the CEO of Willis-Knighton Health System?
Jaf Fielder is the President and Chief Executive Offer (CEO) of Willis-Knighton (WK) Health System, the leading health care provider in Northwest Louisiana.
How many employees does Willis-Knighton Health System have?
Our nearly 8,000 team members live and work right here in Shreveport and Bossier City.
Who has the best medical center in the US?
World's Best Hospitals 2023 RankPublication NameState1Mayo Clinic - RochesterMN2Cleveland ClinicOH3Massachusetts General HospitalMA4The Johns Hopkins HospitalMD71 more rows
What EMR does Willis-Knighton use?
Willis-Knighton Health System, a Shreveport, LA-based not-for-profit healthcare system, today announced it has signed to implement MEDITECH's mobile, web-based Enterprise Health Record (EHR), Expanse, across its five hospitals and 140 clinics.
How many hospitals does Willis-Knighton have?
From one small hospital, Willis-Knighton has grown to encompass multiple facilities, spanning the entire continuum of care for residents in northwest Louisiana and the Ark-La-Tex. Today the health system includes four hospitals as well as a retirement community and a full range of support services.
How big is Willis-Knighton Medical Center?
Willis-Knighton Health System (1,192 total beds - 901 acute and 291 skilled) is the largest medical center in Louisiana with 51,343 inpatient and observation admissions, 3,962 deliveries and buildings that encompass some 3.8 million heated square feet (more than 600 acres) on four hospital campuses.
Where is Willis-Knighton Medical Center headquarters?
Willis-Knighton Medical Center is located at 2600 Greenwood Road (Highway 80). The hospital is easily accessed off Interstate 20 by taking either the Greenwood Road or Hearne Avenue exit.
What is Willis-Knighton Health System ranked?
Willis-Knighton Medical Center tops Newsweek's Best-in-State Hospitals 2024. Willis-Knighton Medical Center has been named the top hospital in Louisiana in a list compiled by Newsweek magazine, in collaboration with Statista Inc., a global marketing research and consumer data company.
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