Patient Demographic sheet

Patient Demographics sheet contains all the basic information about an individual or patient.  Patient demographics have been classified into five major headings


Patient Information
Patient employer information
Patient guarantor information
Physician information
Insurance information. 


Patient Information consists

Account #

Patient Name 

            It is entered as Last name, First Name, Middle Initial format

Patient Date of Birth 

           It is entered in the MM/DD/YYYY or MMDDYYYY as per the Billing

Sex

         It contains the Gender of the patients. i.e., M for Male, F for Female, and U                   for Unknown when the gender of the patient is not specified on the patient encounter Form. 

Patient SSN 

            It contains a 9 digit number which is allotted to the patient by the Social Security Administration.( About SSN - The President Franklin Roosevelt signed the Social Security Act on August 14, 1935. Taxes were collected for the first time in January 1937 and the first one-time, lump-sum payments were made that same month. Regular ongoing monthly benefits started in January 1940)

        Social Security numbers are assigned by Social Security Administration. SSNs were first issued in November 1936. By December 1, 2002 more than 418 million numbers had been assigned.

Patient Gender

           It contains the Marital Status of the patient. It is usually entered as ‘S’ for Single, ‘M’ for Married, ‘D’ for Divorced, ‘W’ for Widows and ‘O’ for Others. 

Patient Address:

     It is usually entered as Address1 (PO Box#/Door#/Appt. #), Address2 (Street/Ave. /Blvd. Name), City, State and ZIP code.

 

Patient phone number

       It contains the contact number of the patient including the area code. It contains a total of 10 digits (111-222-3333), the first 3 digits are the area code, and the next 7 digits are the phone number of the patient. 

Patient Employer information

It contains

Employer Code

Employer Name

Employer Address & Phone #

                        Contact details

Patient Guarantor Information

It Contains

Guarantor Name

Guarantor Address

Guarantor phone #

Guarantor/patient relationship

Guarantor employer & SSN 

Physician Information

It contains

Attending or Rendering physician name

Referring Physician/Primary Care physician name 

Insurance Information

Insurance Name

Effective Date

Subscriber's Name

Relationship Code (Option)

Subscriber Policy #

Claim Mailing address

Every information is important because it would help us to send the clean claim and get the payment immediately and will directly impact physician’s monthly revenue.  This sheet is also called as face sheet of a charge or claim.