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Name: Address: City×Province: Postal Code: Phone: Home: Other: NUCLEAR MEDICINE REQUISITION Procedure and Consultation Health Card # Tel (519× 7515599 Fax (519× 7515582 In Patient Out Patient DOB
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To fill out the in patient out patient form, follow these steps:

01
Familiarize yourself with the form: Read the form thoroughly to understand the information it requires and any specific instructions provided.
02
Provide personal information: Fill in your name, date of birth, address, and contact details as requested. This helps identify the patient accurately.
03
Specify the treatment status: Tick the appropriate box to indicate whether you are filling the form as an in patient or out patient. This determines the level of care you will receive.
04
Detail medical history: Provide a comprehensive account of your medical history, including any previous illnesses, surgeries, allergies, and medications. This ensures appropriate treatment and prevents any adverse reactions.
05
Current symptoms: Describe your current symptoms or reason for seeking medical attention. Include relevant details such as the onset, severity, and duration of the symptoms.
06
Medications and treatments: List any medications you are currently taking and any ongoing treatments or therapies. This is essential for accurate diagnosis and avoids potential conflicts with prescribed treatments.
07
Insurance information: If applicable, include your insurance details to facilitate billing and ensure smooth processing of claims.
08
Signature and date: Sign and date the form to acknowledge that the information provided is accurate to the best of your knowledge.

Who needs in patient out patient?

01
Individuals requiring extensive or specialized medical care may need inpatient services. It is suitable for those in need of close monitoring, surgical procedures, or treatments that require overnight stays in a hospital.
02
Outpatient services are suitable for individuals who require medical attention or treatment but do not require overnight stays. This could include routine check-ups, minor procedures, or therapies that can be performed in a healthcare facility without the need for hospitalization.
Note: It is essential to consult a healthcare professional or refer to specific guidelines for accurate completion of the inpatient-outpatient form.
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In patient is a person who stays in a hospital or other healthcare facility for treatment, while out patient is a person who receives treatment at a hospital or healthcare facility without staying overnight.
Healthcare providers and facilities are required to file in patient out patient records.
In patient out patient records can be filled out electronically or on paper, following the guidelines provided by regulatory authorities.
The purpose of in patient out patient records is to document and track the medical treatment and services provided to patients during their stay in a healthcare facility.
Information such as patient demographics, diagnosis, treatment received, medication administered, and discharge instructions must be reported on in patient out patient records.
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