Bmhsc 2026

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The document is a request form for outpatient cardiopulmonary services, including EKG tests, requiring patient information and ICD-10 codes for diagnosis. It outlines the scheduling process, pre-registration options, and instructions for patients upon arrival at Beaufort Memorial Hospital. The document emphasizes the importance of insurance information and invites patient feedback to improve services.

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Click ‘Get Form’ to open the bmhsc document in the editor.
Begin by entering the Patient Account Number in the designated field at the top of the form.
Fill out the Patient Information section, including your address, Social Security Number, name, date of birth, and gender.
In the General Information section, ensure you include an ICD-10 code or diagnosis for each requested service. This is crucial for billing purposes.
Specify the services requested under RT/ Cardiopulmonary Services by checking the appropriate boxes.
List any additional services along with their corresponding ICD-10 codes in the provided spaces.
Add any remarks or special instructions in the designated area to communicate specific needs or concerns.
Finally, indicate your preferred date and time for your procedure at Beaufort Memorial Hospital.

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