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PRINTED: 01×06/2015 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER×SUPPLIER×CIA IDENTIFICATION
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How to fill out forms for outpatient surgery:

01
Start by carefully reading through the form provided by the outpatient surgery center. Make sure you understand each section and what information is being requested.
02
Begin by providing your personal details, such as your full name, date of birth, address, and contact information. This will help the healthcare professionals to identify you correctly.
03
Next, you may be asked to provide your medical history. This includes any past surgeries, medical conditions, allergies, medications you are currently taking, and any previous adverse reactions to anesthesia. Be thorough and provide accurate information as it can affect your treatment.
04
In some cases, you may need to list the name and contact information of your primary care physician or any other healthcare professionals involved in your care. This helps to ensure proper coordination and communication between medical professionals.
05
If you have any known allergies, make sure to clearly indicate them on the form. This includes allergies to medications, latex, or any other substances that could potentially cause a reaction during the surgery.
06
Take note of the section that asks about your current health status. This is where you should mention any symptoms or health concerns that you are currently experiencing. It's essential to be transparent about your health to ensure your safety during the procedure.
07
Sign and date the form once you have completed all the necessary sections. This shows that you have reviewed and provided accurate information. Remember to bring the form with you on the day of your surgery.

Who needs outpatient surgery?

01
Individuals requiring minor surgical procedures that do not necessitate an overnight stay in a hospital may need outpatient surgery. Some common examples include tonsillectomies, dental surgeries, cataract removal, or cosmetic procedures.
02
Patients who prefer the convenience of recovering in the comfort of their own homes rather than staying overnight in a hospital may opt for outpatient surgery.
03
Outpatient surgery is also suitable for patients who are generally healthy and have a low risk of complications during the procedure. It allows for cost savings compared to inpatient procedures.
Note: It's crucial to consult with your healthcare provider to determine if outpatient surgery is appropriate for your specific medical condition or procedure. Every individual case is unique, and a medical professional can guide you in making the right decision for your health.
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Outpatient surgery refers to surgical procedures that do not require an overnight stay in the hospital.
Any healthcare facility or provider that performs outpatient surgeries must file the necessary documentation.
The outpatient surgery documentation must be completed accurately and in accordance with regulatory requirements.
The purpose of outpatient surgery documentation is to track and report on procedures performed outside of a traditional hospital setting.
Information such as the procedure performed, patient demographics, anesthesia used, and any complications must be reported on outpatient surgery forms.
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