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How to use or fill out Surgery Scheduling Form Phone: 903-408-1200 Fax: 903-408
- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Patient Name, Date of Surgery, and Time of Surgery in the designated fields. Ensure accuracy for scheduling purposes.
- Fill in the Surgeon Name and CPT Codes relevant to the procedure. This information is crucial for billing and insurance purposes.
- Detail the Procedure and Pre-op Diagnosis along with ICD-10 codes. These sections help clarify the medical necessity of the surgery.
- Indicate if a Frozen Section or Grafts/Tissue Request is needed by selecting 'Yes' or 'No'. Specify any requirements in the provided fields.
- Complete the Patient Demographics section, including Gender, Date of Birth, Social Security Number, and contact information.
- Ensure all necessary lab tests are checked off under Patient Status. This helps streamline pre-operative preparations.
- Finally, have the Practitioner sign and date at the bottom of the form to validate it before submission.
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