RE: Patient Financial Agreement Form

[Guest guest]

My best recommendation is to go to the resource Guide. That is where I found the one that I individualized for my use. There are tons of great forms on there! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Jelali, TamaraSent: Monday, February 06, 2012 2:59 PMTo: txfinancialcoordinators Subject: Patient Financial Agreement Form I was hoping someone would be willing to share their Patient Financial Agreement Form. Currently we verbally go over their benefits but we do not have a form that breaks down their benefits. Thank you, Tamara JelaliFinancial Coordinatorat town University Hospital(P) (F) (Pager) TXJ01@... CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

[Guest guest]

Great…thanks. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of lisa.christiansen@...Sent: Monday, February 06, 2012 5:22 PMTo: txfinancialcoordinators Subject: RE: Patient Financial Agreement Form My best recommendation is to go to the resource Guide. That is where I found the one that I individualized for my use. There are tons of great forms on there! M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Jelali, TamaraSent: Monday, February 06, 2012 2:59 PMTo: txfinancialcoordinators Subject: Patient Financial Agreement Form I was hoping someone would be willing to share their Patient Financial Agreement Form. Currently we verbally go over their benefits but we do not have a form that breaks down their benefits. Thank you, Tamara JelaliFinancial Coordinatorat town University Hospital(P) (F) (Pager) TXJ01@... CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.