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Content Overview

Understanding Florida Hospital

  1. What is the purpose of the Florida Hospital form?

    The Florida Hospital form is designed to gather essential information from new patients seeking care in the oncology department. It helps streamline the appointment scheduling process and ensures that healthcare providers have the necessary details to deliver appropriate care.

  2. How long does it take to schedule an appointment?

    Every attempt is made to see the patient within 3-5 days from the receipt of the referral request. This timeframe allows the healthcare team to review the submitted information and prepare for the patient’s visit.

  3. What information is required to complete the form?

    The form requires various details, including:

    • Patient's full name and contact information
    • Date of birth
    • Insurance information
    • Reason for the appointment
    • Referring physician's details

    Completing the form accurately helps expedite the referral process.

  4. What should I do if I have questions about the form?

    If you have questions, you can call (386) 231-4050 for assistance. The staff is available to help clarify any aspects of the form or the appointment scheduling process.

  5. How can I submit the completed form?

    You can submit the completed form by emailing it to oncologyscheduling@fhmmc.org or by faxing it to (386) 231-4001. Ensuring that all required documents are included will help facilitate a timely appointment.

Common mistakes

  1. Incomplete Patient Information: Many individuals forget to fill in all required fields, such as the Social Security Number or insurance details. Missing this information can delay the appointment scheduling process.

  2. Incorrect Contact Information: Providing wrong phone numbers or addresses is a common mistake. Ensure that both the primary and secondary phone numbers are accurate, as this is crucial for communication regarding appointments and follow-ups.

  3. Neglecting to Specify the Reason for Appointment: Some patients overlook the section that asks for the reason for the appointment. Clearly stating whether it’s for a new diagnosis, disease progression, or a second opinion helps the medical team prepare adequately.

  4. Forgetting to Send Required Documents: Failing to include necessary documents, such as operating reports or recent lab results, can hinder the referral process. Make sure to double-check the list of required documents before submitting the form.

How to Use Florida Hospital

Completing the Florida Hospital New Patient Intake Form is essential for scheduling an appointment and providing necessary patient information. Once the form is filled out, it should be emailed to the designated address. Follow the steps below to ensure all required information is accurately provided.

  1. Start by entering the patient's first and last name in the designated fields.
  2. Fill in the patient's address, including city, state, and zip code.
  3. Provide the patient's date of birth.
  4. List the patient's primary and secondary phone numbers, indicating which is home, cell, or work.
  5. Enter the patient's Social Security number.
  6. Select the patient's gender by marking either female or male.
  7. Indicate the patient's race.
  8. For insurance information, fill in the primary insurance company name and phone number.
  9. Complete the subscriber’s name, policy number, group number, date of birth, and Social Security number for the primary insurance.
  10. If applicable, provide the same details for secondary insurance.
  11. Indicate if an urgent appointment is needed and provide the reason for the appointment.
  12. Fill in the referring physician's name and phone number, as well as the primary care physician's details.
  13. Include any additional comments or notes relevant to the patient's care.
  14. Once completed, email the form to oncologyscheduling@fhmmc.org.
  15. If necessary, send required medical records via email or fax to expedite the referral process.

File Specs

Fact Name Description
Form Purpose This form is designed for new patients seeking oncology services at Florida Hospital. It helps gather essential patient information and expedite appointment scheduling.
Appointment Scheduling The hospital aims to schedule appointments within 3-5 days of receiving the referral request, ensuring timely care for patients.
Insurance Information Patients must provide details about their primary and secondary insurance, including company names, policy numbers, and subscriber information.
Urgent Appointments The form allows patients to indicate if they require an urgent appointment, which can be crucial for timely diagnosis and treatment.
Required Documents Referring physicians must send specific documents, such as medical history and recent lab results, to facilitate a smooth referral process.
Patient Notification Once an appointment is scheduled, the patient is notified and given a new patient packet containing important information about their upcoming visit.
Governing Laws This form operates under Florida state laws regarding patient privacy and healthcare regulations, including HIPAA compliance.
↓ Florida Hospital PDF Form

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