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The University of Chicago Hospitals Outside Transfer Admission Request Form ? Initial call Date Time Initials ? Referred to Service per Patient Name: MR#: DOB or SSN: ? Transfer from: pH: Requesting
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What is emtala screening form?
EMTALA screening form is a document that is used to assess whether a patient who comes to an emergency department has an emergency medical condition that requires treatment.
Who is required to file emtala screening form?
The healthcare facility or hospital where the patient presents themselves to the emergency department is required to file the EMTALA screening form.
How to fill out emtala screening form?
To fill out the EMTALA screening form, the healthcare provider must evaluate the patient's medical condition and document their findings and assessment in the form.
What is the purpose of emtala screening form?
The purpose of the EMTALA screening form is to ensure that patients with emergency medical conditions receive appropriate medical treatment and are not denied care due to financial or insurance issues.
What information must be reported on emtala screening form?
The EMTALA screening form typically requires the healthcare provider to document the patient's chief complaint, medical history, vital signs, physical examination findings, and the provider's assessment and disposition.
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