Get Basic Patient Information Form

Patient information forms are documents used by healthcare providers to collect patient information such as contact information, medical history, and insurance information.

Information Included in Medical Records Patient identification, contact information, and date of birth. Billing and health insurance details. List of current and chronic ailments and diagnoses. Current medications list with dosage.

demographic – name, address, contact details and NHS number. administrative – details of appointments, or whether they are waiting for a place in a health and care setting such as a care home or hospital ward. medical – information such as symptoms, diagnosis, weight, medicines, treatments and allergies.

Patient data may include information relating to their past and current health or illness, their treatment history, lifestyle choices and genetic data. It may also include biometric data, which is any measurable physical characteristic that can be checked by machine/computer.

More Definitions of Patient Information For example, it can include your name, address, phone number, birthdate, and medical record number.

With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.

Here are specific examples of both physical and electronic PHI that cannot be shared under HIPAA. Healthcare claims. Documentation of doctor's visits. Payment and remittance information. Coordination of healthcare benefits. Claim status. Health claims attachments. Enrollment information in a health plan.

Examples of PHI: Billing information from your doctor. Email to your doctor's office about a medication or prescription you need. Appointment scheduling note with your doctor's office. An MRI scan. Blood test results. Phone records.