Concentra Form PDF Details

We hope you enjoy this blog post about the importance of using a concentra form. We will discuss what a concentra form is, how they help with patient care and how they can improve your hospital's effectiveness. A concentra form is a document that helps medical professionals better organize their work for patients coming in to be admitted. It helps them create an organized schedule for all aspects of the patient's stay from surgery to discharge, as well as foresee any problems before they happen and take steps to prevent them from happening at all. This reduces overall costs by ensuring everything goes smoothly without any delays or changes necessary which would incur extra cost later on if not prevented now.

The listing features information regarding the concentra form. It might be helpful to learn its size, the average time required to fill out the form, the blanks you'll have to fill in, etc.

QuestionAnswer
Form NameConcentra Form
Form Length1 pages
Fillable?Yes
Fillable fields20
Avg. time to fill out4 min 15 sec
Other namesconcentra form, concentra forms, concentra drug test form, concentra release form

Form Preview Example

(Patient Must Present Photo ID at Time of Service)

Authorization for Examination or Treatment

Patient Name: ___________________________________________________

Social Security Number:___________________________________________

Employer: ___________________________________

Date of Birth: __________________________________________________

Street Address:___________________________________

Location Number: ___________________________________

Temporary Staffing Agency: ___________________________________

Work Related

 

Physical Examination

 

T Injury T Illness

T Preplacement

T Baseline

TAnnual T Exit

Date of Injury ___________________________________

DOT Physical Examination

 

Substance Abuse Testing+ (check all that apply)

T Preplacement

T Recertification

T Regulated drug screen T Breath alcohol

Special Examination

 

T Collection only

T Hair collect

TAsbestos

T Respirator

TAudiogram

T Non-regulated drug screen T Rapid drug screen

T Human Performance Evaluation+

T Other _________________

T HAZMAT

T Medical Surveillance

Type of Substance Abuse Testing

T Other _________________

T Preplacement

T Reasonable cause

Billing (check if applicable)

 

T Post-accident

T Random

T Employee to pay charges

 

T Follow-up

 

 

 

 

 

Special instructions/comments: _______________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Authorized by: ______________________________________________________

Please print

Phone: ( ___________________________________________________ ) ______________________________________________________________

+Due to the nature of these specific services, only the patient and staff are allowed in the testing/treatment area. Please alert your employee so that they can make arrangements for children or others that might otherwise be accompanying them to the medical center.

Title: ___________________________________________________________

______________________________________________________

Date

Concentra now offers urgent care services for non-work related illness and injury. We accept many insurance plans.

(Copies of this form are available at www.concentra.com)

© 2008 Concentra Inc. All Rights Reserved. 06/08

How to Edit Concentra Form Online for Free

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Step 1: You can click the orange "Get Form Now" button at the top of this website page.

Step 2: At this point, you're on the file editing page. You may add information, edit current details, highlight certain words or phrases, put crosses or checks, add images, sign the file, erase unwanted fields, etc.

The PDF file you plan to prepare will consist of the following parts:

filling out concentra form part 1

Within the field (cid:84) Non-regulated drug screen, (cid:84) Rapid drug screen, (cid:84) Human Performance, (cid:43), (cid:84) Other, (cid:84) HAZMAT (cid:84) Medical, Type of Substance Abuse Testing, (cid:84) Other, (cid:84) Preplacement (cid:84), Billing (check if applicable), (cid:84) Post-accident, (cid:84) Random, (cid:84) Employee to pay charges, (cid:84) Follow-up, and Special instructions/comments: type in the information that the program asks you to do.

Filling in concentra form step 2

The application will require data to quickly prepare the box Please print, Phone:, Date, Concentra now offers urgent care, (Copies of this form are available, and © 2008 Concentra Inc.

step 3 to entering details in concentra form

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