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PATIENT REGISTRATION FORM Today s Date Clinic Name PATIENT INFORMATION Please use full legal name no nicknames Last Name First Name Middle Initial Address City State Zip Home Phone - Social Security Date of Birth Age Sex Marital Status Drivers Lic Employer Name and Address Work Phone - E-mail Address Cell Phone - Emergency Contact Name Emerg Phone - Please tell us how you heard about us Referred by GUARANTOR INFORMATION List person or insured name responsible for bill - use full legal...
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( ) - *City of birth: *Postal code: Country: Canada United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, United States Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe *Country: *
Video instructions and help with filling out and completing new patient paperwork
Instructions and Help about new patient registration forms
Welcome to met up Make software training part 2 in this tutorial we are going to look at the patient registration form on the main menu click on patient registration button located over here a new window will open up which is the patient registration form before we get started here is a quick made-up tip if you want to jump from one field to another just hit your tab key on your keyboard for instance if you want to jump from this field to this field you can, you hit your tab key and put automatically do that for you the file number account number lookup and extra icons or extra features located within the patient registration form when you are creating a new patient file you will start here at language these three little stars indicate that these fields are compulsory the main family members information must be added in first the only time when you are not going to use a main family members information is when it's a double you see a claim a lot of family members information or addition over here made up will automatically fill in initials for you, you can then add a title over here you add the ID number and the ID number is very important if you do not have an ID number of the patient you can always just add the birthdate of the patient you can fill in zeros further in the field this is however not recommended you will cause duplicates inside the meta program database made up will automatically calculate the age of the patient located over here Marko always add the main family members information at the very top located over here remember to add as many contact details located in these three fields as much as possible in order to contact a patient if you cannot get all of them on other contact numbers if you right-click on the cell phone number it gives you a small window where you can send an SMS from with in map enter the email address over here an email address is very important referred by can sometimes be very important depending on the practice type referred by doctors should be added manually to do this emptied a field and double-click in it and then this window will appear in front of you known as the referring practitioners the main members home address can be added over here one feature of the meta program is when you click on this drop-down button of the extensions or suburb and start typing the program will automatically search for that area and at the same time it will populate the next two fields when the home address and the postal address is the same you can click on this button then it will add it automatically another great feature of MIT up is if the main members postal address let's say for example pure box one two you do not have to type in pure box just hit the tab key on your keyboard, and it will add it for you automatically over here is we can choose to medical aid all the medical aid funds destinations for electronic claims are the same if you choose any of these options the destination will still be the same the only...
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