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Chp.5 (HIT-114)

Face Sheet---Sections and Content

Identification (or demographic)data -complete name-Mailing address-Phone#-Date and place of birth-SS#-Pt.record #-Pt.account #-Gender-Race & ethnicity-Marital status-Admission & discharge date & time*-type of admission(ex:elective,emergency)-Nxt.of.kin name & address-nxt.of.kin contact info
Financial data Third-party payer>>Name>>Address>>Phone#>>Policy#>>Group name & or number>>Insured(guarantor*),name,DOB,Gender,Relationship to pt.,name & address of employer>>Secondary & or supplemental payer information.(all info.collected for primary payer is also coll
Clinical information Admitting(or provisional or working) diagnosis>>Principal diagnoses(1)>>Secondary diagnosis(ex:comorbidities and/or complications,up to 8)>>Principal procedure(1)>>Secondary procedure(s), up to 5.>>Condition of pt. @ discharge>>Authentication by attending