Patient Intake Form Template

What is Patient Intake?

Patient intake is the process through which healthcare organizations collect social and clinical data, consent forms, insurance, payments, and other key pieces of information from new patients prior to their visit to the hospital.

The patient intake process plays an important role in the operational, financial, and clinical success of medical practices and health systems in the healthcare setup. For instance, an efficient, streamlined intake process means a faster rate at which the process of operation and treatment is done and also means shorter wait times. Consistently collecting at the time of service means less bad debt and increased profitability. And gathering clinical data during intake means providers are better able to care for their patients in a better manner and there is an increase in the quality of the procedure and also an improvement in their quality.

Patient intake also offers opportunities to engage with patients at a range of different points in their journey in the hospital and helps in providing a convenient, high-quality experience for the ailing patient. That’s especially important because the intake process is often patients’ first interaction with a healthcare organization, and it sets the tone for their stay at the healthcare center.

What to look in for a Patient intake solution?

Device Options
Does the vendor offer multiple intake modalities in the form of the kiosk, mobile application.

Mobile Adoption
What percentage of clients have adopted the vendor’s mobile intake solution.

Practice Customization
Can patient intake questions be customized to meet the unique needs of your organization (e.g., for each location, provider, specialty, appointment type)?

Insurance Verification
Does the patient intake solution automate eligibility and benefits verification in real-time and by batch? Can staff easily access copay, deductible, and coinsurance information? Our results clearly displayed so staff can manage exceptions prior to and at the time of service?

Patient Payments Functionality
What options are available to patients for paying copays and balances (e.g., mobile, tablets, kiosks, payment plans, card on file, online payments)?

Card Processing
Does the patient intake solution offer better card processing options than your existing processor?

Clinical
Which patient-reported outcomes (PROs) can be included in patient intake workflows.

Patient Activation
How does the patient intake solution support quality improvement initiatives for organizations that participate in value-based/risk-based arrangements?

Appointments
Can patients request or schedule appointments from the website.

Referrals
Can staff manage and track referrals from various different sources and hospitals which would be helpful?

Appointments
Can appointments be scheduled directly from the vendor solution with real-time updates to the system which is provided in the healthcare units?

Utilization
Are you able to monitor how well the solution is being utilized across locations, staff members, and modalities, and are the analytics there that help us to understand what’s going on in the healthcare center?

Clinical Results
Is reporting or data available to meet any of your quality measures?

Patient Experience
Can you track patient satisfaction results by location and provider to identify areas for improvement?

Device and User Management
Does the solution support local device and user management?

Branding
Can the solution have several logos and the brand slogan which could help the people to know about the company?