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MENTAL HEALTH Program:
INPATIENT TREATMENT EXTENSION REQUEST
Please note complete form in BLOCK CAPITALS
Please return this form to mhnurses@cigna.com
Hospital name
Telephone numberPATIENT DETAILS
Name
Member
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How to fill out hospital care report of
How to fill out hospital care report of
01
Start by entering the patient's personal information such as name, age, and contact details.
02
Include details about the reason for hospitalization and any prior medical history.
03
Document all procedures, treatments, and medications administered to the patient during their hospital stay.
04
Include any lab test results, imaging scans, and other diagnostic reports in the care report.
05
Summarize the patient's condition upon admission, during treatment, and at the time of discharge.
06
Obtain necessary signatures from the healthcare team involved in the patient's care.
Who needs hospital care report of?
01
Hospital care reports are needed by medical professionals involved in the care of the patient such as doctors, nurses, and specialists.
02
Insurance companies may also require hospital care reports for billing and reimbursement purposes.
03
Patients or their legal representatives may request a copy of the hospital care report for personal records or to share with other healthcare providers.
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What is hospital care report of?
Hospital care report is a detailed document that outlines the care and treatment provided to a patient during their hospital stay.
Who is required to file hospital care report of?
Healthcare providers, hospitals, and medical facilities are required to file hospital care reports.
How to fill out hospital care report of?
Hospital care reports can be filled out by documenting all the necessary information about the patient's stay, treatment, and outcomes.
What is the purpose of hospital care report of?
The purpose of hospital care report is to provide a comprehensive record of the care provided to a patient during their hospital stay for medical and legal purposes.
What information must be reported on hospital care report of?
Information that must be reported on hospital care report includes patient demographics, diagnosis, treatment plan, medications administered, procedures performed, and discharge instructions.
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