Edit, Download, and Sign the HSHS St. John's Hospital Surgery Scheduling Physician Order

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How do I fill this out?

To fill out this form, you will need to provide detailed information about the patient, the scheduled procedure, and any pre-op and post-op instructions. Make sure to accurately fill in all required fields to ensure a smooth and timely surgery scheduling process. Double-check each section for any errors or omissions before submission.

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How to fill out the HSHS St. John's Hospital Surgery Scheduling Physician Order?

  1. 1

    Gather all necessary patient information.

  2. 2

    Fill in the details of the scheduled procedure.

  3. 3

    Specify any pre-op and post-op instructions.

  4. 4

    Double-check the form for accuracy.

  5. 5

    Submit the form as per the instructions provided.

Who needs the HSHS St. John's Hospital Surgery Scheduling Physician Order?

  1. 1

    Surgeons scheduling a procedure for their patients.

  2. 2

    Hospital staff coordinating surgery times and resources.

  3. 3

    Insurance companies verifying surgery details for coverage.

  4. 4

    Patients needing to provide their information for surgery.

  5. 5

    Medical billing departments processing surgery-related charges.

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    Open the PDF on PrintFriendly.

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    Use the editing tools to make necessary changes.

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    Adjust text, add or remove sections as needed.

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    Review the document for accuracy.

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What are the instructions for submitting this form?

Submit this form via fax to 217-757-6018 or 217-757-6008, or deliver it in person to 800 E. Carpenter St., Springfield, Illinois 62769. Ensure all sections are completed accurately to avoid any delays. Double-check the information before submission.

What are the important dates for this form in 2024 and 2025?

Consult the hospital for specific dates related to surgery scheduling in 2024 and 2025. Ensure all forms are submitted in accordance with the hospital's schedule.

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What is the purpose of this form?

The purpose of this form is to facilitate the scheduling of surgeries at HSHS St. John's Hospital by providing necessary information on the patient and the procedure. It ensures that the hospital staff, physicians, and other relevant parties have all pertinent details for a smooth and efficient surgery process. Accurate completion of this form is crucial for avoiding any delays or issues on the day of the surgery.

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Tell me about this form and its components and fields line-by-line.

The form contains various sections that require specific information to be filled out.
fields
  • 1. Patient Information: Contains fields for the patient's name, date of birth, social security number, and home address.
  • 2. Procedure Details: Includes fields for the procedure date, surgeon, length of procedure, and type of anesthesia.
  • 3. Pre-op Instructions: Fields for pre-op antibiotics, nurse contact details, and pre-op testing requirements.
  • 4. Post-op Instructions: Section for post-op pain block requests and post-op level of care.
  • 5. Insurance Information: Fields for insurance carrier, precert number, and Medicare/Medicaid length of stay.

What happens if I fail to submit this form?

Failure to submit this form can result in delays or cancellation of the scheduled surgery.

  • Surgery Delays: Incomplete forms can cause rescheduling of the surgery.
  • Insurance Issues: Missing information can lead to problems with insurance coverage.
  • Inaccurate Patient Records: Failure to provide complete information can result in errors in the patient's medical records.

How do I know when to use this form?

Use this form when scheduling surgery at HSHS St. John's Hospital.
fields
  • 1. Surgery Scheduling: For setting up the date and time of the surgery.
  • 2. Patient Information: Providing necessary details for patient identification and medical records.
  • 3. Insurance Verification: Ensuring that insurance details are accurate and coverage is confirmed.
  • 4. Medical Instructions: Submitting any pre-op and post-op medical instructions for a smooth surgery process.
  • 5. Coordination of Care: Ensuring all relevant parties have the necessary information for patient care during and after surgery.

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What information do I need to fill out this form?

You will need detailed patient information, procedure details, and any pre-op and post-op instructions.

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Double-check each section for any errors or omissions and use PrintFriendly's tools to review and confirm all information.

What if I need to make changes to the form after submission?

Resubmit the corrected form using PrintFriendly's editing tools to make necessary updates.

Can I use this form for different types of surgeries?

Yes, the form is designed to be adaptable for various surgical procedures.

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