Get the free Bed Hold Service Authorization Request Form

Utilization Management PO Box 3378 Honolulu, Hawaii 968013378 Phone: 4536904, 4536981 Fax: 4536995 Bed Hold Service Authorization Request All fields are mandatory. UM may send back requests that are

How to fill out bed hold service authorization

How to fill out bed hold service authorization:

1. Obtain the bed hold service authorization form from the relevant healthcare provider or agency.
2. Fill in your personal information accurately, including your full name, date of birth, and contact details.
3. Provide the name of the healthcare facility where you will be temporarily absent from and the date of your planned absence.
4. Indicate the reason for your absence, whether it is for hospitalization, rehabilitation, or any other medical treatment.
5. Include the expected duration of your absence from the healthcare facility.
6. If applicable, provide the name and contact information of the caregiver or family member who will be assisting you during your absence.
7. Sign and date the bed hold service authorization form, certifying that the provided information is accurate.
8. Submit the completed form to the appropriate healthcare provider or agency as instructed.

Who needs bed hold service authorization?

1. Individuals who are residing in a healthcare facility but need to temporarily leave for medical treatment or hospitalization.
2. Patients who require a bed hold service to ensure their accommodation is reserved during their absence.
3. Caregivers or family members who are requesting the bed hold service on behalf of the patient and will be responsible for their care during the absence.

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What is bed hold service authorization?

Bed hold service authorization is a process that allows a patient to temporarily hold their spot in a facility while they are away.

Who is required to file bed hold service authorization?

The patient or their authorized representative is required to file bed hold service authorization.

How to fill out bed hold service authorization?

Bed hold service authorization can be filled out by providing the necessary patient information, reason for absence, expected return date, and any other requested details.

What is the purpose of bed hold service authorization?

The purpose of bed hold service authorization is to ensure that the patient's bed in a facility is held for them during their absence.

What information must be reported on bed hold service authorization?

Information such as patient's name, facility name, reason for absence, expected return date, and contact information must be reported on bed hold service authorization.