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PROVIDENCE HOSPITAL 6801 Airport Boulevard, Mobile AL 36608, 251/6331000 NEWBORN ADMISSION CHARGE SHEET LABS Newborn (Neonatal) RPR (ALL babies) 5015 Infants of Positive / Negative mothers 3258 Infants
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How to fill out newborn admission charge sheet
How to fill out a newborn admission charge sheet:
01
Obtain the newborn admission charge sheet form from the hospital or healthcare facility you will be using for your newborn's care.
02
Begin by filling out your personal information, including your full name, contact information, and any other necessary details such as your address or emergency contact information.
03
Next, provide the required information about your newborn, such as their full name, date of birth, gender, and any other relevant details requested on the form.
04
Fill in the details regarding the healthcare provider or facility where the charge sheet will be submitted. This may include the name, address, and contact information of the hospital or clinic.
05
Indicate the reason for the newborn's admission, such as general check-up, specific medical condition, or birth-related procedure.
06
If the newborn is covered by any insurance, provide the necessary insurance information, including the policy number, group number, and any other relevant details.
07
Complete any sections related to financial responsibility, including information about your own health insurance coverage and any co-pays or deductibles that may apply.
08
Sign and date the form to certify that the information provided is accurate and complete.
Who needs a newborn admission charge sheet:
01
Parents or legal guardians of a newborn baby who is being admitted to a hospital or healthcare facility.
02
Healthcare providers or hospital staff who require the admission charge sheet as part of their administrative or billing processes.
03
Insurance companies or third-party payers who may need the information on the admission charge sheet for claims processing or verification purposes.
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