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Service Plus: Emergent, Urgent & Direct Admissions Authorization Request Form For Hospital Use only Phone: 18883728633 8 a.m. 5:30 p.m. MF Fax: 18003393554 Anytime day or night Fax Clinical notes
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How to fill out service plus emergent urgent:

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Start by gathering all the necessary information, such as the patient's personal details, medical history, and current symptoms or issues.
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Make sure to clearly indicate the urgency of the situation and the need for immediate attention.
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Provide detailed information about any previous treatments or medications the patient has received for the same condition.
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Clearly state the desired outcome or goal of the urgent service needed.
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If applicable, provide any additional relevant information or supporting documents that may assist in the decision-making process.

Who needs service plus emergent urgent:

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Patients who are experiencing severe or life-threatening symptoms that require immediate medical attention.
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Individuals who have tried other methods of treatment without success and need urgent intervention.
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Those who have a pre-existing medical condition that has suddenly worsened or become critical and requires immediate intervention.
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Patients who have been granted urgent status by their healthcare provider or have been referred for immediate care.
Remember, service plus emergent urgent is designed for those who require immediate attention due to the severity or urgency of their condition. It is crucial to provide accurate and detailed information during the filling out process to ensure that the patient's needs are properly addressed.
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2014 NPI SNF PICU C-Section ICU M-F LTC Apgar June19 Hospitalist PEDS Multi applicable Gestation Emergent notification UR Telemetry specify faxed Vaginal Updated Pediatrician Provider Pediatric

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