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   Patient Information Sheets

There are two different types of patient information sheets to use: Commercial or Cash patients sheet and Personal Injury/Worker's Compensation patients sheet.


   Commerical or Cash Patients

The Commercial or Cash patient information sheet should be used on any patients with commercial health insurance, such as BCBS products, Coventry, or Humana. You may also use this sheet for Medicare, Medicaid, or Cash patients. Cash patients only need the top portion completed. Download PATIENT_INFO2_-_comm_or_cash_form.doc

   Personal Injury/Worker's Compensation Patients

The Personal Injury/Worker's Compensation patient information sheet should be filled out according to the type of patient. If you have a Personal Injury patient, you would indicate which type of insurance you are filing for the patient, such as Med-Pay, PIP, or Third-Party Liability. You may also use this sheet for Slip & Fall patients or Settlement Case patients that only have an attorney on file without insurance carrier information. Download PATIENT_INFO2_-_PI_OR_WC.doc

   Daysheet

The daysheet is used to forward patient services and payments for data entry. Download PAGE1_DAILY.doc


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