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How to fill out the Davita Admissions Intake Form online
The Davita Admissions Intake Form is an essential document for securing placement in dialysis facilities. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.
Follow the steps to fill out the Davita Admissions Intake Form online.
- To obtain the form, press the ‘Get Form’ button. This will allow you to access and open the document in a suitable editor.
- Begin by providing essential contact information, including your name, date, contact number, hospital or practice name, and the attending nephrologist's name. Ensure all details are accurate.
- Fill out the patient's information, including their name and any relevant notes.
- In Step 1 for Placement, detail the first day of dialysis ever and the patient's diagnosis. Select the modality of treatment, such as in-center hemodialysis or home hemodialysis.
- Indicate the preferred schedule for treatment by selecting the duration and frequency, such as 2x, 3x, or 4x per week.
- Specify the access type by selecting from options like catheter or fistula and indicate the Hep B antigen status.
- Enter the anticipated DaVita start date, and if unknown, check the corresponding box. Mention requested facilities or zip code.
- Answer any questions regarding special needs, such as the presence of a tracheostomy or requirement for treatment in a bed.
- Proceed to Step 2 by preparing the required documents to fax prior to admission, ensuring you have the Hep B antigen results and any other requested medical records.
- After completing all steps, save your changes, and choose whether to download, print, or share the form as needed.
Complete your forms online for a smooth admissions process.
The fax number for DaVita dialysis admissions may vary depending on your location. It's advisable to check the official DaVita website or contact them directly for the most accurate information. Having the correct fax number is essential when submitting documents related to the DaVita Admissions Intake Form.
Fill Davita Admissions Intake Form
Submission of this form without the full Hep B, but with HBsAg at a minimum, constitutes a request for emergency admission. Proactively complete the High Acuity Questionnaire in the DaVita® Placement Portal (DPP), or fill out the HASTE form and return to DaVita as soon as possible. This form captures necessary patient details and special requirements. Complete it fully to ensure a smooth admission process. To secure a placement, please COMPLETE this form and FAX it along with the Face Sheet (insurance and demographics). STEP 1 :: For Placement. To submit the DaVita Admissions Intake Form, you have several options. Serviço hospitalar. A DaVita está presente nos hospitais com o que há de mais moderno em terapia renal. The following information must be provided from the hospital up front and prior to admission acceptance.
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