Get the free Magee-Womens Hospital Initial Evaluation Form - UPMC.com

For Office Use Only Date Received BMI Division of Minimally Invasive Bariatric and General Surgery Anita Corollas, MD Giselle Haman, MD Carol McCloskey, MD Ramesh Samantha, MD INITIAL EVALUATION FORM

How to fill out magee-womens hospital initial evaluation

How to fill out the Magee-Womens Hospital initial evaluation:

1. Start by gathering all necessary personal information, such as your full name, date of birth, address, and contact information.
2. Provide details about your medical history, including any previous illnesses, surgeries, or medical conditions. Be sure to mention any allergies or medications you are currently taking.
3. Fill in the section regarding your obstetric history if applicable. Include information about previous pregnancies, deliveries, and any complications that may have occurred.
4. Answer questions related to your current pregnancy if applicable. This may include details about your current gestational age, estimated due date, and any prenatal care you have received so far.
5. Mention any specific concerns or symptoms you are experiencing that prompted you to seek an evaluation at Magee-Womens Hospital. This could include issues such as high blood pressure, gestational diabetes, or fetal abnormalities.
6. Provide information about your insurance coverage, including your primary insurance provider and policy number.
7. Review the completed evaluation form for accuracy and completeness before submitting it to the hospital.

Who needs the Magee-Womens Hospital initial evaluation:

1. Pregnant women who are seeking specialized care and services related to prenatal, obstetric, or gynecological needs.
2. Women experiencing high-risk pregnancies or complications that require the expertise and resources available at Magee-Womens Hospital.
3. Patients who have been referred by their primary healthcare provider for further evaluation or specialized treatment.
4. Individuals seeking the comprehensive services and support offered by Magee-Womens Hospital for reproductive health and wellness.
5. Women who prefer to receive care from a renowned women's hospital with a multidisciplinary team of experts in women's health.

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What is magee-womens hospital initial evaluation?

Magee-Womens Hospital initial evaluation is a form that gathers important information about a patient's medical history and current condition when they first arrive at the hospital.

Who is required to file magee-womens hospital initial evaluation?

Medical staff members are required to fill out the Magee-Womens Hospital initial evaluation for each new patient that arrives at the hospital.

How to fill out magee-womens hospital initial evaluation?

The Magee-Womens Hospital initial evaluation form typically includes sections for patient demographics, medical history, current medications, allergies, and reason for hospital admission. Medical staff members must accurately fill out all required fields.

What is the purpose of magee-womens hospital initial evaluation?

The purpose of Magee-Womens Hospital initial evaluation is to provide healthcare providers with essential information about the patient's medical history and current condition to deliver appropriate care.

What information must be reported on magee-womens hospital initial evaluation?

The Magee-Womens Hospital initial evaluation form must include the patient's name, age, gender, medical history, current medications, allergies, vital signs, and reason for hospital admission.