Name______Date______Time______

Procedure 6-1: Making an Appointment for a New Patient

Equipment/Items Needed: Patient’s demographic information, patient’s chief complaint, appointment book or computer with appointment software

Standards: Given the needed equipment and a place to work, the student will perform this skill with _____ % accuracy in a total of _____ minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.)

Key: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

Procedure Steps / self / PARTNER / INSTRUCTOR
1. Obtained as much information as possible from the patient, such as
• Full name and correct spelling
• Mailing address (not all offices require this)
• Day and evening telephone numbers
• Reason for the visit
• Name of the referring person / o / o / o
2. Determined the patient’s chief complaint or the reason for seeing the physician / o / o / o
3. Explained the payment policy of the practice and instructed the patient to bring all pertinent insurance information / o / o / o
4. Gave concise directions, if needed / o / o / o
5. Asked the patient if it is permissible to call at home or at work / o / o / o
6. Confirmed the time and date of the appointment / o / o / o
7. Checked the appointment book to be sure that you have placed the appointment on the correct day in the right time slot / o / o / o
8. If the patient was referred by another physician, called that physician’s office before the appointment for copies of laboratory work, radiology, pathology reports, and so on; gave this information to the physician before the patient’s appointment / o / o / o

Calculation

Total Possible Points: _____

Total Points Earned: _____ Multiplied by 100 = _____

Divided by Total Possible Points = _____%

Pass Fail

o o

Student’s signature ______Date ______

Partner’s signature ______Date ______

Instructor’s signature ______Date ______

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