WorksheetsPatient Intake
Total questions: 20
Worksheet time: 10mins
Name
Class
Date
1.
What information is NOT on the patient demographic sheet?
a)
Name
b)
Social Security
c)
Prescriptions
d)
Date of Birth
2.
How often are patient contact methods supposed to be updated?
a)
Upon first visit
b)
Every visit
c)
Once a year
d)
Once a month
3.
What act serves to protect patients with disabilities?
a)
AMA
b)
OSHA
c)
HIPAA
d)
ADA
4.
What accommodations can be done for a patient who is visually impaired?
a)
Large print
b)
Dull areas
c)
Quiet areas
d)
Interpreter
5.
What accommodations can be done for a patient who is hearing impaired?
a)
Move patient to quiet area
b)
Speak loudly
c)
Use braille forms
d)
Use large print
6.
How can CMAA avoid language barriers with patients?
a)
Have an interpreter
b)
Have forms printed in other languages
c)
Have multi-language software
d)
All of the above
7.
Which of the following are Advance Directive Forms?
a)
DNR
b)
Living Will
c)
POA
d)
All of the above
8.
Which Advanced Directive is help responsible for making health decisions for a patient who is unable to make decisions for themselves?
a)
Living Will
b)
Power of Attorney
c)
Health Surrogate
d)
Organ Donor
9.
Which act serves to protect private health information for patients?
a)
OSHA
b)
HIPAA
c)
Social security
d)
ADA
10.
What paperwork is required to release patient information?
a)
Living will
b)
Demographic sheet
c)
CMS-1500
d)
ROI
11.
What is the primary purpose of health insurance?
a)
To treat the patient
b)
To protect patient from financial burden
c)
To provide services to the patient
d)
None of the above
12.
What is needed to verify eligibility?
a)
Checking the demographic sheet
b)
Copy of insurance card and drivers license
c)
Call insurance company
d)
All of the above
13.
How often is Medicaid verified?
a)
Once a year
b)
Upon first visit
c)
At every visit
d)
Once every 5 years
14.
How often does a patient’s insurance needs to be verified?
a)
Every visit
b)
Upon first visit
c)
Annually
d)
1st and annually
15.
What is the purpose of a preauthorization?
a)
To ask permission for a service
b)
To document a service
c)
To refer a patient
d)
To verify insurance
16.
What is another name for a pre authorization?
a)
Referral
b)
EOB
c)
ROI
d)
Precertification
17.
What is the purpose of a referral?
a)
To refer a patient to a specialist
b)
To create an appointment for a patient
c)
To accommodate a patient
d)
To ask permission for a service
18.
When would the CMAA mail paperwork to a patient?
a)
A patient with vision loss
b)
To make information available
c)
To accommodate a patient with language barriers
d)
All of the above
19.
Are precertifications and referrals the same?
a)
Yes
b)
No
20.
When does paperwork need to be shredded?
a)
If it contains PHI
b)
If it has marital status
c)
If it had patient date of birth
d)
If it had patient phone number
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