When it comes to health, it becomes immensely important for the health care service as well as the providers to know all the details about the patient. Information as simple as the patient’s gender can give lots of clues about the disease, its diagnosis, and appropriate management well in time. This would otherwise be almost impossible to treat the patient at all or treat them in a basic satisfactory way.
Information about the patient was previously collected in the form of manual data forms, which was a little more time-consuming and need too much energy. New patient enrollment forms are a new way to efficiently enter all the details of the patient and use the same information for reference in the future.
If you are a healthcare facility and interested in the new patient enrollment form, you need to know some basic requirements while finalizing the form. Let’s investigate the details and break them down one by one.
As mentioned, the patient’s basic data can be simple information for anyone else. But in the field of healthcare, it means so much because many diseases, and their management is age and gender-specific. It is sometimes even profession specific.
So, any new patient enrollment form will begin with the name, age, and gender of the patient. You can simply put the details while asking the same. Then comes the contact number and address and the kinship rows. This is important to follow the patient for future health follow-up and update them. In case of an emergency, next emergency contact is also needed to make the emergency treatment even more hassle-free. The marital status of the patient is also added in the section ‘introduction’.
History related to health
The patient’s health history then comes the priority when using the new patient enrollment form. Once we are done with the basic information, a couple of rows and columns must be dedicated to the past medical and surgical history of the patient. We need to know a little detail if there is any significant history.
We also want to know about the history of smoking, addiction, allergies, and use of any drug of any kind now or in the past. The urinary and bowel habits are also important to know because it also helps in reaching the diagnosis and assessing if the quality of life is affected by the current illness.
Health insurance details are an integral part of any new patient enrollment form. The health insurance date of issuance and expiry date. The maximum limit of health insurance and other details are also mentioned in this section. We also mention the type of insurance in which we know about the medical coverage for surgery, accident, childbirth, and outpatient limits. Health insurance of the family members if any is also included in the same section.
The last section of the new patient enrollment form includes the signatures of the person who fills the form and is also signed by the patient.
Simple form [MS Word]
- Request Letter for Doctor Appointment
- Maternity Leave Extension Request Letter
- Abortion Note from Doctor
- Diagnosis Note from Psychologist
- Quotation Letter for Medical Services
- Mental Health Excuse Messages (letters)
- Mental Health Letter by Doctor
- Absence Excuse Message for Health Issue
- Stomach Pain Excuse Notes
- Personal Health Record Sheet
- Apology Message to Doctor for Various Reasons
- Menstrual Cramps Excuse Work Note
- Excuse Letter for Absence due to Medical Checkup
- Character Certificate Letter for Medical Admission
- Reasonable Accommodation Request Letter from Doctor