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Independent Care Health Plan Provider Reference Manual Exhibit 1 Inpatient Admission Notification Form INPATIENT ADMISSION NOTIFICATION Independent Care Health Plan (icier) reviews all admissions

How to fill out exhibit 1 inpatient admission

How to fill out exhibit 1 inpatient admission:

1. Gather all necessary patient information, including their name, date of birth, social security number, and admission date.
2. Enter the patient's primary diagnosis and any secondary diagnoses that are relevant to their inpatient stay.
3. Indicate whether the admission is scheduled or unscheduled, and provide the reason for the admission.
4. Specify the source of admission, whether it is from the emergency department, a transfer from another facility, or another source.
5. Provide the name and contact information for the attending physician responsible for the patient's care during their inpatient stay.
6. Include any relevant history and physical findings, such as vital signs, lab results, or imaging studies.
7. Detail the patient's current medications, allergies, and any known sensitivities.
8. Document any procedures or surgeries performed on the patient prior to admission.
9. Indicate the level of care required by the patient, such as intensive care, general care, or specialized care.
10. Finally, review the completed exhibit 1 inpatient admission form for accuracy and completeness before submitting it to the appropriate department or personnel.

Who needs exhibit 1 inpatient admission?

Exhibit 1 inpatient admission is typically required by hospitals, healthcare facilities, and medical professionals. It serves as an important documentation tool to collect and record essential information about a patient's admission, including their diagnosis, treatment, and care plan. This form is necessary for the facility's administrative purposes, as well as for insurance billing and reimbursement purposes. The attending physician responsible for the patient's care during their inpatient stay will also need this form to provide accurate and comprehensive medical records.

For pdfFiller’s FAQs

What is exhibit 1 inpatient admission?

Exhibit 1 inpatient admission is a form used to report detailed information about inpatient hospital stays for Medicaid reimbursement purposes.

Who is required to file exhibit 1 inpatient admission?

Hospitals that provide inpatient services and seek Medicaid reimbursement are required to file exhibit 1 inpatient admission.

How to fill out exhibit 1 inpatient admission?

Exhibit 1 inpatient admission must be completed accurately with all required information about the patient, services provided, and costs incurred during the inpatient stay.

What is the purpose of exhibit 1 inpatient admission?

The purpose of exhibit 1 inpatient admission is to ensure proper documentation and reporting of inpatient hospital stays for Medicaid reimbursement.

What information must be reported on exhibit 1 inpatient admission?

Information such as patient demographics, diagnosis, treatment provided, length of stay, and charges incurred must be reported on exhibit 1 inpatient admission.

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