Get Ca Sharp Memorial Hospital Spine Surgery Scheduling Form 2014-2025

This guide provides clear and supportive instructions for users seeking to complete the CA Sharp Memorial Hospital Spine Surgery Scheduling Form online. By following these steps, you can ensure all required information is accurately filled out for your scheduling needs.

Follow the steps to effectively fill out your scheduling form

1. Press the ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by checking the box for either 'Initial Booking' or 'Modified Booking' and provide a brief description of the modification if applicable.
3. Enter the date of scheduling and the contact person's name along with their phone number.
4. Provide the patient's last name and first name, along with the complete address, including city, state, and ZIP code.
5. Input the home and cell phone numbers, the patient's date of birth, sex, and social security number.
6. Select one of the options for admission type: inpatient, short stay, outpatient, or in house.
7. Fill out the surgeon's name, the assistant or second surgeon's name, and indicate if a proctor is involved.
8. Specify the surgery date and time, provide an estimated length of the procedure, and input the pre-operative diagnosis.
9. Choose the laterality of the surgery as left, right, bilateral, or not applicable.
10. Detail the surgical procedure planned, including any imaging procedures.
11. Indicate if imaging was performed at a specified location and provide additional details if necessary.
12. Fill out additional patient information including their email address, height, weight, and insurance details.
13. Provide the necessary authorization number and indicate if pending.
14. List any CPT codes required for the scheduling.
15. Indicate specific equipment or additional needs required for the procedure.
16. At the end, check all the information for accuracy, then save changes, and download or print the completed form as necessary.

Complete your scheduling form online today for a seamless experience.