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Central scheduling one step form - Kettering Health Network 2026

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45 votes

The document is a Central Scheduling One Step Form used for scheduling medical imaging and laboratory services. It includes fields for patient information, insurance details, requested procedures, and physician contact information. The form outlines various lab tests, radiology services, and outpatient facilities available within the Kettering Health Network, emphasizing the need for precertification and providing contact numbers for scheduling.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the 'Patient Name' and 'DOB' fields. Ensure all required fields are completed accurately.
Select your preferred method of contact by checking the appropriate box for Home, Work, Cell, or Email.
Enter the patient's Social Security Number (SSN) and any relevant ICD10 codes along with written diagnosis(es).
Indicate the patient's sex by selecting either Male or Female. Fill in the precertification number and insurance details including expiration date.
In the lab section, check all applicable tests needed for the patient. Be sure to review each category carefully.
Complete any special notes or additional information as necessary before signing at the bottom of the form.

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Versions	Form popularity	Fillable & printable
2018	4.7 Satisfied (45 Votes)
2016	4.9 Satisfied (34 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What religious affiliation is Kettering Health Network?

Today, Kettering Health maintains its Seventh-day Adventist Church roots across its healthcare system and is affiliated geographically with the Columbia Union Conference of Seventh-day Adventists, which coordinates the Churchs work and healthcare mission in the Mid-Atlantic United States.

What religion is Kettering Health Network?

KHN-Organization-Wide Policy Effective January 1, 2012, Kettering Health Network will no longer hire individuals who use tobacco or nicotine products in any form.

Whats going on with the Kettering Health Network?

The investigation determined there was unauthorized access to Ketterings network between April 9, 2025, and May 20, 2025, and that certain files and folders within the network were viewed and/or taken without authorization during that time.

What happened with Kettering Health?

Exactly what happened? On May 20, 2025, Kettering Health was impacted by a cybersecurity incident linked to a group known as Interlock. We responded immediately to secure our systems and protect patient data. Since then, we have been restoring systems and enhancing security.

What is the Kettering Health controversy?

Data BdocHub: Class Action Brought Against Kettering Health over 730,000 Stolen Patient Records. A class action lawsuit has been filed against Kettering Health in the Montgomery County Court of Common Pleas in Dayton, Ohio following a May 20, 2025 data bdocHub where hackers stole 730,000 files of patient data.

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Kettering Health Central Scheduling Phone number MyChart Kettering

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What is Kettering hospital known for?

Memorial Sloan Kettering Cancer Center (MSK) has been recognized as the best cancer center in the Northeast, the number two hospital for cancer care in the nation, and the number one hospital nationally for urology care by U.S. News World Report in its annual Best Hospitals listing.