Get the free New Patient Information

This document is a comprehensive form used by Watergate Dental Associates to collect personal, employment, medical, dental, billing, and insurance information from new patients.

How to fill out new patient information

How to fill out New Patient Information

1. Start with personal information: Fill in your first and last name.
2. Provide your date of birth.
3. Enter your contact information, including your address, phone number, and email address.
4. Indicate your insurance information, if applicable, including the provider and policy number.
5. List any allergies or medical conditions you have.
6. Include information about any current medications you are taking.
7. Provide information about your primary care physician or any specialists you have seen.
8. Sign and date the form to verify that the information is accurate.

Who needs New Patient Information?

1. New patients visiting a healthcare facility for the first time.
2. Patients transferring from one healthcare provider to another.
3. Individuals who have not been enrolled in a healthcare system previously.

People Also Ask about

What is the 3 year rule for new patients?

By CPT definition, a new patient is “one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.” By contrast, an established patient has received professional services from the physician or

What are the new patient guidelines for Medicare?

Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty) within the previous 3 years.

What is the 3 year new patient rule?

Introduce yourself. Provide a warm, friendly smile when you meet your patient. Extend your hand for a handshake. Look the patient in the eye. Be conscious of your body language. Give the patient your undivided attention. Ask them how they are doing.

Is a new patient visit covered by Medicare?

Part B (Medical Insurance) Covers certain doctors' services, outpatient care, medical supplies, and preventive services. covers one “Welcome to Medicare” preventive visit within the first 12 months you have Part B. This "Welcome to Medicare" visit isn't a physical exam.

How many years of absence must pass before a patient is considered a new patient again?

A new patient is one who has not received any professional services, [e.g., E/M service or other face-to-face service (e.g., surgical procedure)] from the physician or physician group practice (same physician specialty) within the previous 3 years.

What information should be gathered from a new patient?

Medicare has stated that a patient is a new patient if no face-to-face service was reported in the last three years. The group practice and specialty distinctions still apply, but “professional service” is limited to face-to-face encounters.

For pdfFiller’s FAQs

What is New Patient Information?

New Patient Information refers to the documentation and data collected from individuals who are seeking medical services for the first time at a particular healthcare facility or practice.

Who is required to file New Patient Information?

New patients seeking medical care at a healthcare facility are required to file New Patient Information.

How to fill out New Patient Information?

To fill out New Patient Information, patients typically need to complete a questionnaire that includes personal details, contact information, medical history, and insurance information.

What is the purpose of New Patient Information?

The purpose of New Patient Information is to gather essential details that help healthcare providers ensure appropriate care, understand the patient's medical history, and facilitate efficient billing and insurance procedures.

What information must be reported on New Patient Information?

Information that must be reported on New Patient Information includes the patient's full name, date of birth, contact details, insurance information, medical history, current medications, and allergies.