Get Utah Emergency Department Encounter Database - Health Utah

Filling out the UTAH EMERGENCY DEPARTMENT ENCOUNTER DATABASE is essential for reporting emergency department encounters in Utah. This guide provides step-by-step instructions to help users accurately and effectively complete the form online.

Follow the steps to complete the UTAH EMERGENCY DEPARTMENT ENCOUNTER DATABASE.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by filling out the provider identifier, which is a code representing the hospital from which the patient was released.
3. Enter the patient’s age category using the provided coding system, indicating their age as of their last birthday.
4. Indicate the patient’s gender by selecting the appropriate code (M for male, F for female, etc.).
5. For non-newborn patients, specify the source of admission by choosing the relevant code (e.g., physician referral or emergency department visit).
6. Document the length of stay in hours from the time of admission to discharge.
7. Select the patient's discharge status, which indicates the outcome of their visit (e.g., released to home, transferred to another facility).
8. Fill in the patient’s postal zip code and residential county, ensuring the accuracy of the address as required by the form.
9. Complete sections on marital status, race and ethnicity, principal diagnosis code, secondary diagnosis codes, and procedure codes, referring to ICD-9-CM as needed.
10. Specify the charges associated with the encounter, including total charge and emergency department charge.
11. Indicate the primary, secondary, and tertiary payer categories that correspond to the patient's insurance.
12. Complete the outlier fields as necessary, indicating if the encounter's charges or length of stay exceed the predetermined thresholds.
13. Finally, review all entered information for accuracy and completeness before saving or submitting the form. Options may include saving changes, downloading, printing, or sharing the filled form.

Complete your forms online with confidence and accuracy to support emergency department data reporting in Utah.