Easily Insert Last Name Field to the Patient Discharge Form

Reduce time spent on papers administration and Insert Last Name Field to the Patient Discharge Form with DocHub

Time is a vital resource that each enterprise treasures and attempts to turn into a gain. When choosing document management application, take note of a clutterless and user-friendly interface that empowers users. DocHub delivers cutting-edge tools to maximize your document administration and transforms your PDF file editing into a matter of one click. Insert Last Name Field to the Patient Discharge Form with DocHub to save a ton of time and enhance your productiveness.

A step-by-step instructions on how to Insert Last Name Field to the Patient Discharge Form

Drag and drop your document in your Dashboard or upload it from cloud storage services.
Use DocHub innovative PDF file editing features to Insert Last Name Field to the Patient Discharge Form.
Modify your document making more adjustments if required.
Include fillable fields and allocate them to a certain recipient.
Download or send your document to the customers or colleagues to securely eSign it.
Get access to your files within your Documents folder whenever you want.
Create reusable templates for commonly used files.

Make PDF file editing an simple and easy intuitive operation that will save you plenty of valuable time. Effortlessly adjust your files and send them for signing without looking at third-party options. Focus on pertinent tasks and increase your document administration with DocHub today.

PDF editing simplified with DocHub

Seamless PDF editing

Editing a PDF is as simple as working in a Word document. You can add text, drawings, highlights, and redact or annotate your document without affecting its quality. No rasterized text or removed fields. Use an online PDF editor to get your perfect document in minutes.

Smooth teamwork

Collaborate on documents with your team using a desktop or mobile device. Let others view, edit, comment on, and sign your documents online. You can also make your form public and share its URL anywhere.

Automatic saving

Every change you make in a document is automatically saved to the cloud and synchronized across all devices in real-time. No need to send new versions of a document or worry about losing information.

Google integrations

DocHub integrates with Google Workspace so you can import, edit, and sign your documents directly from your Gmail, Google Drive, and Dropbox. When finished, export documents to Google Drive or import your Google Address Book and share the document with your contacts.

Powerful PDF tools on your mobile device

Keep your work flowing even when you're away from your computer. DocHub works on mobile just as easily as it does on desktop. Edit, annotate, and sign documents from the convenience of your smartphone or tablet. No need to install the app.

Secure document sharing and storage

Instantly share, email, and fax documents in a secure and compliant way. Set a password, place your documents in encrypted folders, and enable recipient authentication to control who accesses your documents. When completed, keep your documents secure in the cloud.

Drive efficiency with the DocHub add-on for Google Workspace

Access documents and edit, sign, and share them straight from your favorite Google Apps.

Install now

How to Insert Last Name Field to the Patient Discharge Form

4.6 out of 5

21 votes

Welcome to PDF Run! In this video, well guide you on how to fill out a Hospital Discharge Paper! A Discharge Paper is a sample form only for patients who are ready to leave the clinic or hospital. Before discharging patients from the hospital, certain information must be on file. For this purpose, a discharge paper may help to gather patient information, follow-up plan, and any other data needed for a successful discharge. Discharge papers must be kept confidential by hospitals or clinics as it contains detailed information about the patient. This discharge form is simple and straightforward. It contains six parts: Patient Details, Primary Healthcare Professional Details, Admission and Discharge Details, Diagnosis and Procedures, Medication Details, and Prepared by section. To fill out the Discharge Paper, click on the Fill Online button. This will redirect you to PDF Runs online editor. For the first section, enter the required details of the patient. To start, input the first name.

Related features

Convert PDF to HTML5 on OnePlus

Convert PDF to HTML5 on Mobile

Convert PDF to HTML5 in Android

Convert PDF to HTML5 in iOS

Convert PDF to HTML5 in Microsoft’s mobile OS

Convert PDF to HTML5 in Windows

Convert PDF to HTML5 in macOS

Convert PDF to HTML5 in Linux

Got questions?

Below are some common questions from our customers that may provide you with the answer you're looking for. If you can't find an answer to your question, please don't hesitate to reach out to us.

Contact us

What is field 17 on a claim form?

Information about Item 17 (Name of Referring Provider or Other Source) Item 17 of the CMS-1500 (02-12) claim form is reserved for the Referring Provider or Other Source.

What goes in box 17a on CMS 1500?

Box 17a. The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.

What is DN for Box 17 on HCFA 1500?

Box 17 - Name of Referring Provider or Other Source DNReferring ProviderDKOrdering ProviderDQSupervising Provider

What goes in box 21A on CMS 1500?

21A is entered in the Diagnosis Pointer field (Box 24E) to reference the applicable diagnosis code in Box 21A. If the claim for aid-in-dying drugs is submitted by the attending physician, an invoice documenting the cost of the drugs must be submitted as an attachment.

What is qualifier code box 17?

Box 17 identifies the name of the referring provider on the claim. Enter the applicable qualifier to the left of the vertical dotted line to identify which provider is being reported.

What is Box 39 on UB04?

Box 39-41; a-d Value codes and amounts: (Optional) Use these locators to indicate codes and amounts essential to the proper adjudication of the submitted claim. Each form locator contains a three digit field in which to key the indicator code, and a larger free text field in which to designate an applicable amount.

What is field 17 on a UB04?

17. * Patient Status Enter the 2-digit patient status code that best describes the patients discharge status. 05-Discharged/transferred to another type of institution for inpatient care or referred for outpatient services to another institution.

What is field 11 in CMS 1500 claim form?

The street address, area, state, ZIP code, and telephone number are included. Box 11: This field requires the insureds policy or group number to be filled.

See why our customers choose DocHub

Great solution for PDF docs with very little pre-knowledge required.

"Simplicity, familiarity with the menu and user-friendly. It's easy to navigate, make changes and edit whatever you may need. Because it's used alongside Google, the document is always saved, so you don't have to worry about it."

Pam Driscoll F
Teacher

A Valuable Document Signer for Small Businesses.

"I love that DocHub is incredibly affordable and customizable. It truly does everything I need it to do, without a large price tag like some of its more well known competitors. I am able to send secure documents directly to me clients emails and via in real time when they are viewing and making alterations to a document."

Jiovany A
Small-Business

I can create refillable copies for the templates that I select and then I can publish those.

"I like to work and organize my work in the appropriate way to meet and even exceed the demands that are made daily in the office, so I enjoy working with PDF files, I think they are more professional and versatile, they allow..."

Victoria G
Small-Business

be ready to get more

Edit and sign PDFfor free

Get started now

Insert Last Name Field to the Patient Discharge Form