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Patient Registration
Patient Registration
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Created by Qualaris Staff
Critical Access Hospital
Registration
Table of Contents
Audit Form
Audit Form
Patient Registration
Required
Observed Date
Registrar
Registrar 1
Registrar 2
Registrar 3
Other
Patient Registration Checklist
Mark all as...
Pt contact info
Yes
No
Pt employer
Yes
No
N/A
Pt SSN
Yes
No
N/A
Pt DOB
Yes
No
Guar contact info
Yes
No
Guar employer
Yes
No
N/A
Guar SSN
Yes
No
N/A
Guar DOB
Yes
No
Insurance info
Yes
No
Insurance verified
Yes
No
N/A
Insurance carrier listed
Yes
No
N/A
Insurance billing address correct
Yes
No
N/A
Insurance ID info correct
Yes
No
N/A
Insurance mnemonic correct
Yes
No
Patient status
Yes
No
Admission date correct
Yes
No
Information scanned
Yes
No
Drivers license
Yes
No
N/A
Insurance card
Yes
No
N/A
Medical Order scanned
Yes
No
N/A
Consent scanned
Yes
No
