GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
9. ✦ Be sure also to record the name
of the individual with whom you
spoke and the creation of the
reminder card.
10. ✦ Notify the patient of the
date and time of the
appointment, and provide the
reminder card.
11. ✦ Verify that the patient
knows the oce location. If
not, provide clearly written
directions.
12. ✶ Forward any pertinent information
such as laboratory tests or X-rays
to the physician’s oce, and
record them in the patient’s chart.
If faxing information, be sure to
place the fax confirmation in the
patient’s chart.
13. ✶ If precertification is required,
contact the patient’s insurance
company and request
authorization. Depending
on the insurance carrier,
this may be done either by
computer, telephone, or fax.
The insurance company will
require the following information:
specialist’s name, telephone
number, and reason for the visit
or request.
14. ✦ If completing the precertification
by telephone, document the
precertification number and the
name and telephone number of
the individual who provides the
number.
Name: ________________________________________
Date: _________________________________________
POINT VALUE
✦ = 3–6 points
✶ = 7–9 points
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