{"id":15313,"date":"2018-11-07T18:43:13","date_gmt":"2018-11-07T18:43:13","guid":{"rendered":"https:\/\/www.process.st\/templates\/patient-intake-checklist-for-a-medical-clinic\/"},"modified":"2024-02-28T21:50:56","modified_gmt":"2024-02-28T21:50:56","slug":"patient-intake-checklist-for-a-medical-clinic","status":"publish","type":"post","link":"https:\/\/www.process.st\/templates\/patient-intake-checklist-for-a-medical-clinic\/","title":{"rendered":"Patient Intake Checklist for a Medical Clinic"},"content":{"rendered":"<section id=\"introduction\">\n<h2>Introduction:<\/h2>\n<div class=\"image-content\">\n<figure>\n   <a href=\"https:\/\/www.process.st\/templates\/wp-content\/uploads\/2024\/02\/m1ChWvC1Aau73GSX115GBw.png\" alt=\"Introduction:\" target=\"_blank\" rel=\"noopener\"> <img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/www.process.st\/templates\/wp-content\/uploads\/2024\/02\/m1ChWvC1Aau73GSX115GBw.png\"> <\/a><br \/>\n  <\/figure>\n<\/p><\/div>\n<div class=\"text-content\">\n<p><span><a href=\"https:\/\/www.hopkinsmedicine.org\/news\/media\/releases\/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us\" rel=\"nofollow\">Studies suggest<\/a>&nbsp;that <strong>paperwork&nbsp;errors&nbsp;are the 3rd leading cause of death<\/strong> in the United States alone.<\/span><\/p>\n<p><span>Thus, patient intake is arguably <strong>the most important part of any medical clinic's patient interaction cycle<\/strong>. It is the point of entry for the patient and will set the tone for the rest of your relationship, whilst establishing the infrastructure for paperwork and data storage.<\/span><\/p>\n<p><span>There are three main elements that make up a <strong>good patient intake process<\/strong>:<\/span><\/p>\n<ol>\n<li>Proper handling of patient's time, data, and privacy<\/li>\n<li><span>Making the process as convenient as possible for the patient<\/span><\/li>\n<li><span>Making sure all communication is clear and overstated<\/span><\/li>\n<\/ol>\n<p>The patient intake process gives you an opportunity to get everything you need to properly assess and start working with the patient. <strong>Compliance plays a big part<\/strong> in this, with HIPAA documents and needing to be signed both before patients enter into your system of care, and updated at the beginning of each fiscal year.<\/p>\n<p>This <a href=\"https:\/\/www.process.st\/help\/docs\/what-is-the-difference-between-templates-and-checklists\/\" rel=\"nofollow\">checklist template<\/a> was designed to make the patient intake process as streamlined as possible for you and your new patients, using conditional logic and <strong>automation to reduce friction and increase patient satisfaction.<\/strong><\/p>\n<p>What's more, with Process Street's extensive integrations <strong>you won't have to worry about chasing down and filing paperwork<\/strong> - all the manual work will be done for you.<span><\/span><\/p>\n<p>Let's get started with the checklist.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"basic-information\">\n<h2>Basic information:<\/h2>\n<\/section>\n<section id=\"input-basic-information\">\n<h2>Input basic information<\/h2>\n<div class=\"text-content\">\n<p><span>First of all,&nbsp;<\/span><strong><span>fill out some basic details about your patient<\/span><\/strong><span>&nbsp;using the form fields in this task.<\/span><\/p>\n<p class=\"style-info\"><span>Automatically pull information from your medical CRM to fill out this task by setting up one of our many <a href=\"https:\/\/www.process.st\/crm-integration\/\" rel=\"nofollow\">CRM integrations<\/a>.<\/span><\/p>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient first name <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled class=\"form-control\">\n  <\/div>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient last name <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled class=\"form-control\">\n  <\/div>\n<\/p><\/div>\n<div class=\"date-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient date of birth <\/label> <\/p>\n<div class=\"date-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-calendar btn-icon\"><\/i> Date will be set here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient contact number <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled class=\"form-control\">\n  <\/div>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient address <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Reason for calling <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient record exists? <\/label><br \/>\n   <select disabled class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Appointment booked? <\/label><br \/>\n   <select disabled class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<div class=\"text-content\">\n<p>Then<strong> input information about the client's insurance policy.<\/strong><\/p>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Insurance provider <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled class=\"form-control\">\n  <\/div>\n<\/p><\/div>\n<div class=\"text-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient policy number <\/label><br \/>\n   <input type=\"text\" placeholder=\"Something will be typed here...\" disabled class=\"form-control\">\n  <\/div>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Additional insurance information needed? <\/label><br \/>\n   <select disabled class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"request-additional-insurance-information\">\n<h2>Request additional insurance information<\/h2>\n<div class=\"text-content\">\n<p>Use the email widget below to <strong>send a request for additional insurance information.&nbsp;<\/strong><\/p>\n<p class=\"style-info\">Set up one of our <a href=\"https:\/\/www.process.st\/help\/docs\/gmail\/\" rel=\"nofollow\">integrations<\/a> to send a request automatically when a task in this checklist is completed (for example, when the previous task is checked).<\/p>\n<p><strong>Check that the information in the template is accurate<\/strong> before sending it.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"compliance\">\n<h2>Compliance:<\/h2>\n<\/section>\n<section id=\"upload-compliance-documents\">\n<h2>Upload compliance documents<\/h2>\n<div class=\"text-content\">\n<p>Next,<strong> upload your HIPAA and patient consent forms<\/strong>. This way they can be pulled into tasks in this checklist and automatically sent out to your client as and when needed during the onboarding process.<\/p>\n<\/p><\/div>\n<div class=\"file-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Consent and authorization form <\/label> <\/p>\n<div class=\"file-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<div class=\"file-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> HIPAA authorization form <\/label> <\/p>\n<div class=\"file-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"send-hipaa-authorization-form\">\n<h2>Send HIPAA authorization form<\/h2>\n<div class=\"text-content\">\n<p>As required by law, <strong>send your client a<a href=\"https:\/\/www.rocketlawyer.com\/document\/hipaa-authorization-form.rl#\/\" rel=\"nofollow\"> HIPAA authorization form<\/a> <\/strong>to ensure compliance when dealing with their medical records.<\/p>\n<p class=\"style-info\"><span>Automatically send your new clients HIPAA documents by setting up one of our integrations to trigger as soon as you run this checklist.<\/span><span><\/span><\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"receive-signed-hipaa-authorization-form\">\n<h2>Receive signed HIPAA authorization form<\/h2>\n<div class=\"text-content\">\n<p><strong>Upload the signed HIPAA authorization form<\/strong>&nbsp;as soon as you receive it back from your patient using&nbsp;the form field below.<\/p>\n<\/p><\/div>\n<div class=\"file-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Signed HIPAA authorization form <\/label> <\/p>\n<div class=\"file-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"medical-crm\">\n<h2>Medical CRM:<\/h2>\n<\/section>\n<section id=\"create-new-patient-profile-in-medical-crm\">\n<h2>Create new patient profile in medical CRM<\/h2>\n<div class=\"text-content\">\n<p><strong>Create a new patient profile<\/strong> in your <a href=\"https:\/\/www.datamotion.com\/2016\/08\/salesforce-service-cloud-hipaa-compliance\/\" rel=\"nofollow\">HIPAA-compliant CRM of choice<\/a>.<\/p>\n<p class=\"style-info\">You can automate this task with one of Process Street's 1,000+ app integrations. For example, you can <a href=\"https:\/\/www.process.st\/help\/docs\/salesforce\/\" rel=\"nofollow\">set up Salesforce to automate tasks like this<\/a> whenever you run a new checklist.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"ask-patient-for-changes-to-information\">\n<h2>Ask patient for changes to information<\/h2>\n<div class=\"text-content\">\n<p>If the patient record already exists, either as a digital record in your medical CRM or a paper file, <strong>contact them to make sure all of the information you have is up-to-date.&nbsp;<\/strong><\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"record-changes-to-existing-patient-information\">\n<h2>Record changes to existing patient information<\/h2>\n<div class=\"text-content\">\n<p>After checking for a CRM profile and requesting new information from the patient,<strong> record any changes to existing information<\/strong>&nbsp;in the form field below.<\/p>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> New patient information <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"determine-required-documents\">\n<h2>Determine required documents<\/h2>\n<div class=\"text-content\">\n<p><strong>Determine what&nbsp;documents will be needed to proceed with the patient intake<\/strong>; the <a href=\"https:\/\/www.process.st\/help\/docs\/conditional-logic\/\" rel=\"nofollow\">conditional logic<\/a> set up for this checklist will then modify the remaining tasks based on how you fill out the form fields below.<\/p>\n<\/p><\/div>\n<div class=\"multi-choice-content form-field-content\">\n<div class=\"form-group\">\n   <label> Required documents <\/label><br \/>\n   <select disabled class=\"form-control\"><option value=\"\">Multiple options can be selected from this list<\/option><\/select>\n  <\/div>\n<ul class=\"items\">\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       1\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Proof of identification\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       2\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Insurance documents\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       3\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Medical records\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       4\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Other (please specify)\n    <\/div>\n<\/li>\n<\/ul><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Other (please specify) <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"update-medical-crm-with-patient-information\">\n<h2>Update medical CRM with patient information<\/h2>\n<div class=\"text-content\">\n<h4>Patient information<\/h4>\n<p class=\"style-info\">First name:&nbsp;{{form.Patient_first_name}}<br \/>Last name:&nbsp;{{form.Patient_last_name_2}}<br \/>Email address:&nbsp;{{form.Patient_email_address}}<br \/>Contact number:&nbsp;&nbsp;{{form.Patient_contact_number}}<\/p>\n<p>Primary address:&nbsp;{{form.Patient_address}}<\/p>\n<p>Signed HIPAA form:&nbsp;{{form.Signed_HIPAA_authorization_form}}<br \/>Documents outstanding:&nbsp;{{form.Required_documents}}<br \/>Documents outstanding (other):&nbsp;{{form.Other_(please_specify)}}<\/p>\n<p>New information:&nbsp;{{form.New_patient_information}}<\/p>\n<hr>\n<p>The information above is a summary of the information collected so far during this checklist. Use it to <strong>update your patient's medical CRM.<\/strong><\/p>\n<p class=\"style-info\">Save time by automating this task; for example, using one of our <a href=\"https:\/\/zapier.com\/apps\/hubspot\/integrations\/process-street\" rel=\"nofollow\">Hubspot<\/a>&nbsp;integrations.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"welcome\">\n<h2>Welcome:<\/h2>\n<\/section>\n<section id=\"prepare-welcome-email\">\n<h2>Prepare welcome email<\/h2>\n<div class=\"text-content\">\n<p>Use this opportunity to prepare a welcome email; your goal here, as with much of the onboarding process, is to <strong>make the patient feel like they've made the right decision<\/strong> in choosing your practice, whilst also <strong>providing value<\/strong> in some way.<\/p>\n<p><span>Here is a list of content you might consider incorporating into your welcome email:<\/span><\/p>\n<\/p><\/div>\n<div class=\"multi-select-content form-field-content\">\n<ul class=\"items\">\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       1\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Introduction to you \/ your practice\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       2\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Short, relevant video with contextual information\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       3\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Digital brochure containing information about your practice\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       4\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Content referencing you or your practice (blog posts, articles, etc.)\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       5\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Customer testimonials\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       6\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      FAQ\n    <\/div>\n<\/li>\n<\/ul><\/div>\n<div class=\"text-content\">\n<p><strong>Fill the form fields of this task<\/strong> with content for the welcome email.<\/p>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Welcome introduction <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<div class=\"file-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Welcome brochure (.pdf) <\/label> <\/p>\n<div class=\"file-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"send-welcome-email\">\n<h2>Send welcome email<\/h2>\n<div class=\"text-content\">\n<h4><\/h4>\n<p>Using the information collected in the previous task that has automatically been added to the email, <strong>edit<\/strong>&nbsp;<strong>the body of the email below<\/strong> and&nbsp;<span>then<\/span><strong><span>&nbsp;hit the send button&nbsp;<\/span><\/strong><span>when you're ready.<\/span><\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"scheduling\">\n<h2>Scheduling:<\/h2>\n<\/section>\n<section id=\"schedule-intake-appointment\">\n<h2>Schedule intake appointment<\/h2>\n<div class=\"text-content\">\n<p>Send an email with a link to your scheduling tool of choice to <strong>arrange an appointment for the initial intake meeting.<\/strong><\/p>\n<p><strong>Edit the body of the email template&nbsp;<\/strong>to include your own scheduling tool URL.<\/p>\n<\/p><\/div>\n<div class=\"text-content\">\n<p>Check out how you can <strong>automate your client onboarding process using Process Street<\/strong> with the video below:<\/p>\n<\/p><\/div>\n<div class=\"video-content\">\n<div class=\"iframe-container\">\n   <iframe src=\"https:\/\/www.youtube.com\/embed\/0fvQz69b6AM?modestbranding=1&amp;showinfo=0\" frameborder=\"0\" allowfullscreen=\"true\"> <\/iframe>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"confirm-appointment-date\">\n<h2>Confirm appointment date<\/h2>\n<div class=\"text-content\">\n<p>Once the client has booked an appointment with you, <strong>record the date in the form field below.<\/strong><\/p>\n<\/p><\/div>\n<div class=\"date-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Intake appointment date <\/label> <\/p>\n<div class=\"date-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-calendar btn-icon\"><\/i> Date will be set here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"medical-questionnaires\">\n<h2>Medical questionnaires:<\/h2>\n<\/section>\n<section id=\"send-lifestyle-health-questionnaire\">\n<h2>Send lifestyle health questionnaire<\/h2>\n<div class=\"text-content\">\n<p><strong>Send over a questionnaire<\/strong> to get information&nbsp;on the patient's lifestyle and general health, including allergies, existing conditions, and general&nbsp;fitness.<\/p>\n<p>Ideally, the questionnaire should be completed before the appointment.<strong> Edit the email body to include a link to your own questionnaire.<\/strong><\/p>\n<p class=\"style-info\">Set up an email integration to send this questionnaire using one of our many <a href=\"https:\/\/www.process.st\/create-a-form\/\" rel=\"nofollow\">form tool integrations<\/a>.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"send-medical-symptoms-questionnaire-msq\">\n<h2>Send medical symptoms questionnaire (MSQ)<\/h2>\n<div class=\"text-content\">\n<p><strong>Send an additional questionnaire<\/strong> to get information&nbsp;on the patient's symptoms to supplement your assessment ahead of, during, and after their intake appointment.<\/p>\n<p>Again, this questionnaire should be completed before their intake appointment.<strong> Edit the email body to include a link to your own questionnaire.<\/strong><\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"receive-completed-medical-questionnaires\">\n<h2>Receive completed medical questionnaires<\/h2>\n<div class=\"text-content\">\n<p>Once the client has filled out both the lifestyle health and MSQ, <strong>record links to the completed questionnaires in the form field below<\/strong>, using the sub-checklist to keep track.<\/p>\n<\/p><\/div>\n<div class=\"multi-select-content form-field-content\">\n<ul class=\"items\">\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       1\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Lifestyle health questionnaire\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       2\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Medical Symptoms Questionnaire\n    <\/div>\n<\/li>\n<\/ul><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Fasting required before appointment? <\/label><br \/>\n   <select disabled class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"preparation-for-intake-appointment\">\n<h2>Preparation for intake appointment:<\/h2>\n<\/section>\n<section id=\"specify-fasting-requirements\">\n<h2>Specify fasting requirements<\/h2>\n<div class=\"text-content\">\n<p>It may be necessary that the patient takes care to follow specific fasting instructions in preparation for their appointment.<strong> Record specific fasting instructions in the form field below.<\/strong><\/p>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Fasting instructions <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"inform-patient-of-fasting-requirements\">\n<h2>Inform patient of fasting requirements<\/h2>\n<div class=\"text-content\">\n<p><strong>Send an email detailing the specific instructions for fasting<\/strong> that the patient must follow in preparation for the intake appointment.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"request-they-bring-medical-records-to-the-intake-appointment\">\n<h2>Request they bring medical records to the intake appointment<\/h2>\n<div class=\"text-content\">\n<p>Use this email widget to<strong> send a request for specific medical documents and records<\/strong> to be brought to the intake appointment.<\/p>\n<p>The email should already be complete with necessary requests; <strong>check it over and hit the send button<\/strong> before moving to the next task.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"request-copies-of-identification-for-the-appointment\">\n<h2>Request copies of identification for the appointment<\/h2>\n<div class=\"text-content\">\n<p>As with the previous task, the email should already have all of the necessary information; just check it over and <strong>send it once you've confirmed everything looks okay.<\/strong><\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"provide-resources-for-locating-the-clinic\">\n<h2>Provide resources for locating the clinic<\/h2>\n<div class=\"text-content\">\n<p>This may take the form of step-by-step directions (if the clinic is in a difficult location),&nbsp;directions on your website, or may just be a simple Google Maps location.<\/p>\n<p>Whatever the case, use the form field in this task to <strong>provide a resource for informing your client how to reach the physical clinic.<\/strong><\/p>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Clinic directions <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<div class=\"file-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Clinic directions (.pdf) <\/label> <\/p>\n<div class=\"file-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"send-clinic-directions-to-patient\">\n<h2>Send clinic directions to patient<\/h2>\n<div class=\"text-content\">\n<h4>Clinic directions<\/h4>\n<p class=\"style-info\">Clinic directions:&nbsp;{{form.Clinic_directions}}<br \/>Clinic directions (.pdf):&nbsp;{{form.Clinic_directions_(.pdf)}}<br \/>Clinic directions (URL):&nbsp;{{form.Clinic_directions_(URL)}}<\/p>\n<hr>\n<p>Use this email widget to <strong>provide your patient with detailed instructions<\/strong> on how to reach the clinic.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"intake-appointment\">\n<h2>Intake appointment:<\/h2>\n<\/section>\n<section id=\"understand-patients-needs\">\n<h2>Understand patient's needs<\/h2>\n<div class=\"text-content\">\n<p>Either during your intake appointment&nbsp;or afterward (using notes recorded elsewhere) <strong>complete the form field below<\/strong> with as much information as possible regarding your patient's needs.<\/p>\n<\/p><\/div>\n<div class=\"textarea-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Overview of patient's situation <\/label><br \/>\n   <textarea placeholder=\"Something will be typed here...\" rows=\"3\" disabled class=\"form-control\"><\/textarea>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"after-intake-appointment\">\n<h2>After intake appointment:<\/h2>\n<\/section>\n<section id=\"upload-copies-of-proof-of-identification\">\n<h2>Upload copies of proof of identification<\/h2>\n<div class=\"file-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Proof of identification <\/label> <\/p>\n<div class=\"file-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"assess-whether-consent-and-authorization-form-is-necessary\">\n<h2>Assess whether consent and authorization form is necessary<\/h2>\n<div class=\"text-content\">\n<p><span>A consent form is not required for simple diagnostic tests or treatments in which consent is clearly implied. <\/span><\/p>\n<p><span>Treatment which puts the patient in more vulnerable positions or has the potential to seriously harm them. That's why it's important a consent and authorization form be signed beforehand, so that the patient understands the risk they are incurring.&nbsp;<\/span><\/p>\n<p><span>After having met with the patient and discussed their needs in more detail, <strong>determine whether or not a consent and authorization form will be necessary.<\/strong><\/span><\/p>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Consent and authorization form required? <\/label><br \/>\n   <select disabled class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"send-consent-and-authorization-forms-for-signing\">\n<h2>Send consent and authorization forms for signing<\/h2>\n<div class=\"text-content\">\n<p><strong>Send your patient a consent and authorization form<\/strong> to sign using the email widget below. Everything should be prepared for you; simply <strong>check the body of the email before sending.<\/strong><\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"receive-signed-consent-and-authorization-forms\">\n<h2>Receive signed consent and authorization forms<\/h2>\n<div class=\"text-content\">\n<p>Once you've received the signed consent and authorization form from your client, <strong>upload a copy to the form field here.<\/strong><\/p>\n<\/p><\/div>\n<div class=\"file-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Signed consent and authorization form <\/label> <\/p>\n<div class=\"file-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-upload btn-icon\"><\/i> File will be uploaded here <\/button>\n   <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"securely-store-patients-medical-records\">\n<h2>Securely store patient's medical records<\/h2>\n<div class=\"text-content\">\n<p>Having received your patient's medical records, <strong>be sure that they are securely stored<\/strong> (either uploaded or paper copies made) to your clinic database before proceeding.<\/p>\n<\/p><\/div>\n<div class=\"multi-select-content form-field-content\">\n<ul class=\"items\">\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       1\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Patient's medical records secured (digital)\n    <\/div>\n<\/li>\n<li class=\"item\">\n<div class=\"step-number-container\">\n<div class=\"step-number\">\n       2\n     <\/div>\n<\/p><\/div>\n<div class=\"step-checkbox-container\">\n<div class=\"step-checkbox\"><\/div>\n<\/p><\/div>\n<div class=\"item-name-static\">\n      Patients medical records secured (paper)\n    <\/div>\n<\/li>\n<\/ul><\/div>\n<\/section>\n<section id=\"update-medical-crm-with-new-information\">\n<h2>Update medical CRM with new information<\/h2>\n<div class=\"text-content\">\n<h4>New patient information<\/h4>\n<p class=\"style-info\">Reason for calling:&nbsp;{{form.Reason_for_calling}}<br \/>Overview:&nbsp;{{form.Overview_of_patient's_situation}}<\/p>\n<p>Lifestyle health questionnaire (complete):&nbsp;{{form.Completed_lifestyle_health_questionnaire_URL}}<br \/>MSQ (complete):&nbsp;{{form.Completed_MSQ_URL}}<\/p>\n<p>Proof of identification:&nbsp;{{form.Proof_of_identification}}<br \/>Signed consent and authorization form:&nbsp;{{form.Signed_consent_and_authorization_form}}<\/p>\n<hr>\n<p>Using the information conveniently collected in the text field above, <strong>update the patient's profile in your medical CRM.<\/strong><\/p>\n<p class=\"style-info\">Set up one of our integrations to have this information automatically sent to your medical CRM. Check out how you can do this with <a href=\"https:\/\/zapier.com\/apps\/hubspot\/integrations\/process-street\" rel=\"nofollow noopener\" target=\"_blank\">Hubspot<\/a>, or <a href=\"https:\/\/www.process.st\/help\/docs\/zapier\/\" rel=\"nofollow\">1,000+ other applications<\/a>.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"insurance-coverage\">\n<h2>Insurance coverage:<\/h2>\n<\/section>\n<section id=\"check-insurance-coverage\">\n<h2>Check insurance coverage<\/h2>\n<div class=\"text-content\">\n<p>Are the needs of the patient within the coverage of their current insurance plan?<\/p>\n<p>We've made it simple to provide alternative options for your patient using conditional logic to modify the tasks in this checklist based on the response recorded in the drop-down form field of this task.<\/p>\n<p>Determine the answer and <strong>record their coverage in the form field below.<\/strong><\/p>\n<\/p><\/div>\n<div class=\"select-field-content form-field-content\">\n<div class=\"form-group\">\n   <label> Patient covered by insurance? <\/label><br \/>\n   <select disabled class=\"form-control\"><option value=\"An option will be selected here\">An option will be selected here<\/option><\/select>\n  <\/div>\n<\/p><\/div>\n<\/section>\n<section id=\"provide-payment-options\">\n<h2>Provide payment options<\/h2>\n<div class=\"text-content\">\n<p><strong>Send the patient an email informing them of the different payment options available<\/strong>, in the event that their insurance plan does not cover treatment at your practice.<\/p>\n<p>You can <strong>edit the body of the email template <\/strong>to include your own payment options.<\/p>\n<p class=\"style-info\">Automatically send this email as soon as you've determined their coverage by setting up an email integration. <a href=\"https:\/\/zapier.com\/apps\/mailchimp\/integrations\/process-street\" rel=\"nofollow\">MailChimp<\/a> and <a href=\"https:\/\/www.process.st\/help\/docs\/gmail\/\" rel=\"nofollow\">Gmail<\/a> both work great for this.<\/p>\n<\/p><\/div>\n<\/section>\n<section id=\"sources\">\n<h2>Sources:<\/h2>\n<div class=\"text-content\">\n<ul>\n<li><a href=\"https:\/\/www.accessefm.com\" rel=\"nofollow\">Access EFM<\/a> - <a href=\"https:\/\/www.accessefm.com\/blog\/patient-intake-process-4-ways-to-improve-patient-satisfaction\" rel=\"nofollow noopener\" target=\"_blank\">4 Ways to Improve Patient Satisfaction<\/a><\/li>\n<li><a href=\"https:\/\/blog.intakeq.com\" rel=\"nofollow\">IntakeIQ<\/a> - <a href=\"https:\/\/blog.intakeq.com\/the-new-method-of-patient-intake-and-how-it-will-help-your-practice\/\" rel=\"nofollow noopener\" target=\"_blank\">New Method of Patient Intake and How it will Help Your Practice<\/a><\/li>\n<li><a href=\"https:\/\/blog.intakeq.com\" rel=\"nofollow\">IntakeIQ<\/a> - <a href=\"https:\/\/blog.intakeq.com\/10-tips-to-optimize-your-patient-intake-forms\/\" rel=\"nofollow noopener\" target=\"_blank\">10 Tips to Optimize Patient Intake Forms<\/a><\/li>\n<li><a href=\"https:\/\/insightmg.com\/\" rel=\"nofollow\">InsightMG<\/a> - <a href=\"https:\/\/insightmg.com\/getting-the-most-out-of-every-phone-call-to-your-practice\/\" rel=\"nofollow noopener\" target=\"_blank\">Getting the Most out of Every Phone Call to Your Practice<\/a><\/li>\n<li><a href=\"https:\/\/reviewob.com\" rel=\"nofollow\">ReviewOB<\/a> - <a href=\"https:\/\/reviewob.com\/getting-on-track-with-the-medical-model-patient-intake-process\/\" rel=\"nofollow noopener\" target=\"_blank\">Getting On Track with the Medical Model: Patient Intake Process<\/a><\/li>\n<li><a href=\"https:\/\/www.beckershospitalreview.com\" rel=\"nofollow\">Becker's Hospital Review<\/a> - <a href=\"https:\/\/www.beckershospitalreview.com\/healthcare-information-technology\/documentation-checklists.html\" rel=\"nofollow noopener\" target=\"_blank\">Healthcare Information: Documentation Checklists<\/a><\/li>\n<li><a href=\"https:\/\/www.verywellhealth.com\" rel=\"nofollow\">VeryWellHealth.com<\/a> - <a href=\"https:\/\/www.verywellhealth.com\/medical-record-checklist-2317250#\" rel=\"nofollow noopener\" target=\"_blank\">Medical Records Checklist<\/a><\/li>\n<li><a href=\"https:\/\/cchealth.org\" rel=\"nofollow\">CCHealth<\/a> - <a href=\"https:\/\/cchealth.org\/hiv\/contractor\/pdf\/intake-policy-instructions.pdf\" rel=\"nofollow noopener\" target=\"_blank\">Intake Policy<\/a><\/li>\n<li><a href=\"https:\/\/www.thecoachingtoolscompany.com\" rel=\"nofollow\">TheCoachingToolsCompany<\/a> - <a href=\"https:\/\/www.thecoachingtoolscompany.com\/products\/intake-session-template-checklist\/\" rel=\"nofollow noopener\" target=\"_blank\">Intake Session Template Checklist<\/a><\/li>\n<li><a href=\"https:\/\/knowledgebase.practicefusion.com\" rel=\"nofollow\">PracticeFusion<\/a> - <a href=\"https:\/\/knowledgebase.practicefusion.com\/knowledgebase\/articles\/487648-how-do-i-process-patient-intake-online-check-in\" rel=\"nofollow noopener\" target=\"_blank\">How Do I Process Patient Intake?<\/a><\/li>\n<li><a href=\"https:\/\/intakeq.com\" rel=\"nofollow\">IntakeIQ<\/a> - <a href=\"https:\/\/intakeq.com\/support\/hipaa-compliant-online-intake-forms\" rel=\"nofollow noopener\" target=\"_blank\">HIPAA Compliant Online Intake Forms<\/a><\/li>\n<li><a href=\"https:\/\/medmaldirect.com\" rel=\"nofollow\">MedMalDirect<\/a> - <a href=\"https:\/\/medmaldirect.com\/risk-education\/content\/articles\/steps-to-a-seamless-patient-intake-process\/\" rel=\"nofollow noopener\" target=\"_blank\">Steps to a Seamless Patient Intake Process<\/a><\/li>\n<li><a href=\"https:\/\/www.drlmassoumi.com\" rel=\"nofollow\">Dr L Massoumi<\/a> - <a href=\"https:\/\/www.drlmassoumi.com\/uploads\/7\/0\/8\/6\/7086290\/intake_forms_all_in_one_document.pdf&nbsp;\" rel=\"nofollow noopener\" target=\"_blank\">Intake Forms - All-In-One Document<\/a><\/li>\n<\/ul><\/div>\n<\/section>\n<section id=\"related-checklists\">\n<h2>Related checklists:<\/h2>\n<div class=\"text-content\">\n<ul>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-for-a-marketing-agency\/\" rel=\"nofollow noopener\" target=\"_blank\">Client Onboarding Checklist for a Marketing Agency<\/a><\/span><\/li>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-for-financial-planners\/\" rel=\"nofollow noopener\" target=\"_blank\">Client Onboarding for Financial Planners<\/a><\/span><\/li>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-for-criminal-law-firms\" rel=\"nofollow noopener\" target=\"_blank\">Client Onboarding Checklist for Criminal Law Firms<\/a><\/span><\/li>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/high-touch-client-onboarding-for-saas-companies\/\" rel=\"nofollow noopener\" target=\"_blank\">High Touch Client Onboarding for SaaS Companies<\/a><\/span><\/li>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/website-design-client-onboarding-template\/\" rel=\"nofollow noopener\" target=\"_blank\">Website Design Client Onboarding Template<\/a><\/span><\/li>\n<li><a href=\"https:\/\/www.process.st\/templates\/landlord-onboarding-checklist\/\" rel=\"nofollow noopener\" target=\"_blank\"><span>Landlord Onboarding Checklist<\/span><\/a><span><\/span><\/li>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-checklist-for-an-accounting-firm\" rel=\"nofollow noopener\" target=\"_blank\">Client Onboarding Checklist for an Accounting Firm<\/a><\/span><\/li>\n<li><a href=\"https:\/\/www.process.st\/templates\/patient-intake-for-a-dental-clinic\/\" rel=\"nofollow noopener\" target=\"_blank\"><span>Patient Intake Checklist<\/span><span> for a <\/span><span>Dental Clinic<\/span><\/a><\/li>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-checklist-for-real-estate\" rel=\"nofollow noopener\" target=\"_blank\">Client Onboarding Checklist for Real Estate Sales<\/a><\/span><\/li>\n<li><span><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-process-for-a-managed-service-provider\/\" rel=\"nofollow noopener\" target=\"_blank\">Client Onboarding Checklist for a Managed Service Provider<\/a><\/span><\/li>\n<li><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-checklist-for-a-software-development-company\/\" rel=\"nofollow noopener\" target=\"_blank\"><span>Client Onboarding Checklist<\/span><span> for a Software<\/span><span> Development Company<\/span><\/a><\/li>\n<li><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-checklist-for-management-consulting\/\" rel=\"nofollow noopener\" target=\"_blank\"><span>Client Onboarding <\/span><span>Checklist <\/span><span>for Management Consulting<\/span><\/a><\/li>\n<li><a href=\"https:\/\/www.process.st\/templates\/client-onboarding-checklist-for-an-insurance-broker\/\" rel=\"nofollow noopener\" target=\"_blank\"><span>Client Onboarding Checklist<\/span><span> for an <\/span><span>Insurance Broker&nbsp;<\/span><\/a><\/li>\n<\/ul><\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>Introduction: Studies suggest&nbsp;that paperwork&nbsp;errors&nbsp;are the 3rd leading cause of death in the United States alone. Thus, patient intake is arguably the most important part of any medical clinic's patient interaction cycle. It is the point of entry for the patient and will set the tone for the rest of your relationship, whilst establishing the infrastructure [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":15314,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"ep_exclude_from_search":false,"cover_icon_emoji":"","cover_icon_url":"","tasks_count":"45","template_description":"Run this checklist for each new medical patient to make the intake process as easy as possible for them and ensure maximum retention.","template_id":"i4Oqsa5PUztAeazI7_dHiw","task_0":"Introduction:","task_slug_0":"introduction","task_1":"Basic information:","task_slug_1":"basic-information","task_2":"Input basic information","task_slug_2":"input-basic-information","task_3":"Request additional insurance information","task_slug_3":"request-additional-insurance-information","task_4":"Compliance:","task_slug_4":"compliance","task_5":"Upload compliance documents","task_slug_5":"upload-compliance-documents","task_6":"Send HIPAA authorization form","task_slug_6":"send-hipaa-authorization-form","task_7":"Receive signed HIPAA authorization form","task_slug_7":"receive-signed-hipaa-authorization-form","task_8":"Medical CRM:","task_slug_8":"medical-crm","task_9":"Create new patient profile in medical CRM","task_slug_9":"create-new-patient-profile-in-medical-crm","task_10":"Ask patient for changes to information","task_slug_10":"ask-patient-for-changes-to-information","task_11":"Record changes to existing patient information","task_slug_11":"record-changes-to-existing-patient-information","task_12":"Determine required documents","task_slug_12":"determine-required-documents","task_13":"Update medical CRM with patient information","task_slug_13":"update-medical-crm-with-patient-information","task_14":"Welcome:","task_slug_14":"welcome","task_15":"Prepare welcome email","task_slug_15":"prepare-welcome-email","task_16":"Send welcome email","task_slug_16":"send-welcome-email","task_17":"Scheduling:","task_slug_17":"scheduling","task_18":"Schedule intake appointment","task_slug_18":"schedule-intake-appointment","task_19":"Confirm appointment date","task_slug_19":"confirm-appointment-date","task_20":"Medical questionnaires:","task_slug_20":"medical-questionnaires","task_21":"Send lifestyle health questionnaire","task_slug_21":"send-lifestyle-health-questionnaire","task_22":"Send medical symptoms questionnaire (MSQ)","task_slug_22":"send-medical-symptoms-questionnaire-msq","task_23":"Receive completed medical questionnaires","task_slug_23":"receive-completed-medical-questionnaires","task_24":"Preparation for intake appointment:","task_slug_24":"preparation-for-intake-appointment","task_25":"Specify fasting requirements","task_slug_25":"specify-fasting-requirements","task_26":"Inform patient of fasting requirements","task_slug_26":"inform-patient-of-fasting-requirements","task_27":"Request they bring medical records to 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