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Patient Contact & Authorization for Disclosure of Protected Health Information Patient Information: Name: ___ ID Number: ___ Date of Birth: ___ Address: ___ Telephone: ___ HomeCellPolicy Holder Information:

How to fill out frequency of patient contact

How to fill out frequency of patient contact

1. Record the date and time of each patient contact
2. Note the medium of communication (phone call, email, in-person visit, etc.)
3. Document the purpose of the contact (medical update, appointment scheduling, follow-up, etc.)
4. Indicate the outcome of the contact (appointment scheduled, medication prescribed, information provided, etc.)
5. Include any relevant patient feedback or concerns

Who needs frequency of patient contact?

1. Healthcare professionals such as doctors, nurses, and medical assistants who are involved in the care of patients
2. Healthcare administrators who track patient interactions for quality assurance and compliance purposes
3. Insurance companies who need to verify patient contact for billing and claims processing

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