Browse By

International Patient Intake Form

Health is wealth. A person who is not feeling well would neither be able to do his daily chores nor would he be able to enjoy his life. It is hence very important that each one of us pays special attention to his/her health.

Usually, it is seen that a person visits his nearest available doctor when he is ill. That doctor if not able to diagnose or provide proper care then refers the patient to another hospital. It can be within the same city or outside the city.

In some cases, the disease is so complicated that even the doctors of that other hospital are not able to provide any suitable treatment to the patient so they ask the patients to go to another city or even to another hospital outside the country.

So, if you are in the managing committee of a hospital made on international standards you might get few patients from another country. Before they travel a long distance it is always helpful that the hospital knows what the condition of the patient is and if they have any way of treating him.

This saves time and money for the patient’s family just in case your hospital is unable to provide services they require.

The form usually contains following points:

  • Name of the patient with a date of birth
  • The country to which the patient belongs and his ID card number
  • Complete address of the patient in the parent country
  • A short summary of the current situation of the patient to help the doctors have a little idea beforehand.
  • Medical diagnosis provided to the patient from the parent country
  • Further treatments suggested by the previous doctor
  • Any complications with the disease told by the doctors
  • Previous medical history as this will help the doctors to better deal with the issue.
  • Name of the person who will be paying the expenses in case patient has to be admitted to the hospital.

We here provide you with different templates that are made to have all the above-mentioned points. You can browse through all the available templates and select the one that suits you the best. You can download and use the templates directly for your purpose.


International Patient Intake Form


Leave a Reply

Your email address will not be published. Required fields are marked *