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Please reference our tax ID/EIN 23-1352685, and include the purpose of your gift if possible.
A patient intake form is designed to increase the efficiency of your practice and improve the patient experience. First, your forms need to ask for basic information, like their name, date of birth, age, sex, contact information, emergency contact, employer, and insurance information.
You can now link your myPennMedicine account to your myChart account at other health organizations, such as Jefferson Health. This will let you see more of your health records in one place.
You can request access to your health information from doctors office visits directly through your providers practice. You can request access to your hospital-based health information through the Health Information Management department by emailing HIMRequests@uphs.upenn.edu.
Patient and Visitor Information - Penn Medicine. Schedule a COVID vaccine or booster appointment: Log in to myPennMedicine or call us 8am to 5pm, Monday through Friday, at 267-758-4902.
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General Inquiries Call 800-789-7366 to speak with a customer service representative.
You can request access to your health information from doctors office visits directly through your providers practice. You can request access to your hospital-based health information through the Health Information Management department by emailing HIMRequests@uphs.upenn.edu.
Patient intake is the process through which healthcare organizations collect demographic, social and clinical data, consent forms, insurance, payments and other key pieces of information from new and returning patients prior to their visit.

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