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REFERENCE NUMBER: {{ReferenceNumber}} ADMISSION NUMBER: {{ReferenceId}}

Admission Notification

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NPI Number

HealthSun is contracted with QMC (Miami Dade) and H2 (Broward & Palm Beach) hospitalist groups. Admission must be assigned to one of these hospitalist.

Patient First Name

Required 2-50 letters and - only

Patient MI

0-1 Letter

Patient Last Name

Required 2-100 letters and - only

DOB

Required Invalid date!

Member Number

Admission status

Hospital Name

Hospital Phone

New Hospital Name

New Hospital Phone

Caller First Name

Required 2-50 letters and - only

Caller last Name

Required 2-50 letters and - only

TIN

Call back phone

Admission date

Required Invalid date!

Admission Time

Required
Admission time cannot be set in the future

Admitting Physician First Name

Required 2-50 letters and - only

Admitting Physician Last Name

Required 2-50 letters and - only

ICD10 Codes

Required 2-50 letters and - only Code: {{ $select.selected.NumberCode }}
  • {{icd9Item.NumberCode}} {{icd9Item.Description}}