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1/19/24, 1:07 PM Indiana State Department of Health Hospital Service Reported Hospital Service Report State Form 49476 (R /702) IC 16216Status: Finalized I. Hospital Information Hospital CAMERON MEMORIAL
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How to fill out isdh hospital service report

01
Obtain a copy of the ISDH Hospital Service Report form.
02
Fill in the patient's information, including name, date of birth, and medical record number.
03
Provide details about the services provided during the hospital stay, including dates, types of services, and any procedures done.
04
Include information about any medications administered to the patient during the hospital stay.
05
Complete the form with any additional information required, such as signatures from the healthcare providers involved in the patient's care.
06
Review the completed form for accuracy and completeness before submitting it to the appropriate healthcare authority.

Who needs isdh hospital service report?

01
Healthcare facilities and providers that are required to report information about hospital services to the Indiana State Department of Health (ISDH).
02
Patients or their representatives who may need the ISDH Hospital Service Report for insurance claims or other purposes.
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The ISDH Hospital Service Report is a document that hospitals in Indiana must file, providing detailed information about their services, patient statistics, and other operational metrics.
All licensed acute care hospitals in Indiana are required to file the ISDH Hospital Service Report.
To fill out the ISDH Hospital Service Report, hospitals must collect data on admissions, discharges, patient demographics, financial information, and services provided, and then submit the completed report through the designated online portal or in written form to the Indiana State Department of Health.
The purpose of the ISDH Hospital Service Report is to collect, analyze, and publish data related to hospital performance and services, facilitating transparency and enabling informed decision-making by healthcare policymakers.
Hospitals must report information such as total admissions, total discharges, patient demographics, length of stay, types of services offered, and financial data among other operational statistics.
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