TEMPLATES

HOSPITAL TEMPLATES (CONSULT/ORDERS/CALL BACK)

HOSPITAL CONSULT/STAT CONSULT → UROLOGY AND GI

THIS CALL TYPE IS ONLY FOR HOSPITALS CALLING TO BOOK A CONSULTATION (AT
THE HOSPITAL) ON BEHALF OF A PATIENT

Good morning/afternoon thank you for calling Broward Specialty Group. This is _________
How may I help you?
…

I need to collect some information from you, may I start with the name of the hospital you are
calling from please?
CONSULT
HOSPITAL:
PATIENT:
DOB:
SPECIALTY/DOCTOR:
DIAGNOSIS:
INSURANCE:
ROOM# BED#:
CALLER NAME:
CALLER PHONE NUMBER:
HOSPITAL CALL FOR ORDERS/CALL BACK → UROLOGY AND GI
HOSPITAL:
REQUESTED DOCTOR:
PATIENT:
DOB:
ROOM#:
CALLER NAME:
CALLER PHONE NUMBER:
MESSAGE:

HOSPITAL CONSULT → PAIN MANAGEMENT

HOSPITAL:
PHYSICIAN/TEAM CONSULTING:
REASON FOR THE CONSULT:
INSURANCE:
ROOM#:
PATIENT NAME:
DOB:
CALLER NAME:
CALL BACK NUMBER:
HOSPITAL CALL FOR ORDERS/CALL BACK → PAIN MANAGEMENT
HOSPITAL:
DOCTOR:
PATIENT NAME:
DOB:
ROOM#:
CALLER NAME:
CALL BACK NUMBER:
REASON/MESSAGE:

PCP (PRIMARY DOCTOR) OFFICE TEMPLATE (WHEN THEY CALL FROM PRIMARY
CARE DOCTOR OFFICE TO ASK FOR DOCUMENTS (ORDERS, NOTES, MEDICAL
RECORDS, LAB WORK, MRI, CT SCAN RESULTS) TO BE FAXED)
CALLER NAME: (NAME AND NAME OF THE OFFICE WHERE THEY ARE CALLING FROM)
CALLER PHONE NUMBER:
CALLER FAX NUMBER:
PATIENT:
DOB:
MESSAGE: (EXAMPLE: THEY NEED LAST PATIENT’S NOTES TO BE FAXED)

REFILL OF MEDICATION TEMPLATE

(NAME OF THE DOCTOR)
PATIENT:
DOB:
PHONE NUMBER:
INSURANCE:
PHARMACY NAME:
MESSAGE: (EXAMPLE: PATIENT NEEDS REFILL OF OXYCODONE 10 MG).

ENT TEMPLATE (DR. HINA GUPTA)

PATIENT:
DOB:
PHONE NUMBER:
INSURANCE:
PATIENT TYPE: (NEW OR ESTABLISHED)
MESSAGE:

*DE PRESENTAR ALGÚN INCONVENIENTE CON UN PACIENTE DE ENT, LLAMAR A LAS

EXTENSIONES: 1112 U 1124 PARA QUE SE COMUNIQUEN CON UN MÉDICO ASISTENTE.

*SÓLO CIRUGÍAS A LA EXTENSIÓN 1126

 OPHTHALMOLOGY TEMPLATE (DR. POOJA GARG)
PATIENT:
DOB:
PHONE NUMBER:
INSURANCE:
PATIENT TYPE:
MESSAGE:
*DE PRESENTAR ALGÚN INCONVENIENTE CON UN PACIENTE DE OPHTHALMOLOGY, LLAMAR A
LAS EXTENSIONES: 1115 U 1113 PARA QUE SE COMUNIQUEN CON UN MÉDICO ASISTENTE.

REGULAR CALL BACK TEMPLATE

WHEN PATIENTS CALL TO HAVE A CALL BACK FROM A MEDICAL ASSISTANT

(DOCTOR’S NAME)
PATIENT:
DOB:
PHONE NUMBER:
MESSAGE: (THE PATIENT WANTS DR. COHEN’S ASSISTANT TO CALL THEM BACK BECAUSE…)

RECUERDA, EN TODOS LOS TEMPLATES MENCIONADOS, ENVIAR SOLO INFORMACIÓN

NECESARIA CON EL USO DE PALABRAS CLAVE Y NO OLVIDAR A QUÉ ESPECIALIDAD VA
DIRIGIDA.