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FLAT FEE REQUEST FORM Revenue Integrity Phone: 5417064745 Email: GRP Charge Master stcharleshealthcare.org SURGERY INFORMATION Date Requested: Surgeon: Proposed Procedure: (description of procedure)
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Start by accessing the website bstcharleshealthcare.orgb and navigating to the surgery information page.
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Look for the surgery information form or questionnaire provided on the website.
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Begin filling out the form by entering your personal details such as your full name, date of birth, and contact information.
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Next, provide relevant medical information such as your current health condition, any pre-existing medical conditions, and any medications you are currently taking.
05
If applicable, provide details about any allergies or adverse reactions you have had in the past to medications, anesthesia, or any other substances.
06
Provide a detailed medical history including any previous surgeries you have undergone, any complications or side effects you experienced, and any relevant hospitalizations or procedures.
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Include information about your primary care physician or any specialists involved in your healthcare.
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If necessary, provide information about your insurance coverage and policy details.
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Individuals who are responsible for coordinating a patient's surgery, such as a caregiver or family member, may need to assist in filling out the surgery information on behalf of the patient.
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Surgery information on bstcharleshealthcareorgb refers to details about surgical procedures performed at St. Charles Healthcare.
Medical staff, surgeons, and healthcare professionals who perform surgeries at St. Charles Healthcare are required to file surgery information.
Surgery information can be filled out electronically on the bstcharleshealthcareorgb website or through the hospital's internal reporting system.
The purpose of surgery information is to track and monitor surgical procedures, ensure quality care, and promote transparency in healthcare services.
Details such as patient information, type of surgery, date and time of surgery, surgical team involved, and any complications or adverse events must be reported on surgery information.
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