Patient Signature Clarifications

There has been some confusion regarding which patients can sign for themselves on our Claim Authorization Form. DC Jarrett, AC Manzo, Lt. Flickner, and Billing Manager Cook met and came up with the following in an effort to clarify some of the guidelines. While we know GCS is not the best scale for these purposes, it is the only one we have at this point.

• Every patient with a GCS of 15 regardless of medical history, i.e. dementia, Alzheimer’s, etc... shall sign in section 1 of the form. This is regardless if patient has a POA, Health Care Proxy, DNR/ DNI, etc...
• Alternative signatures should be obtained for patients with the following
  • Patients with GCS < 15
  • Physical disability, chronic or acute, preventing use of a pen
  • Patients under care of a critical care team, i.e.stroke,trauma,etc...and a signature was not able to be obtained prior to arrival at the ED

• You are required to document the reason a patient is not able to sign in Section 2 and 3 of the form. It is expected that all efforts will be made to ascertain a signature enroute to the ED for patients that you know will become unavailable to you upon arrival at the hospital, assuming the GCS is 15. If there is a large gap in your activity log showing you were not busy on the way to the ED and no patient signature is obtained, you should expect questioning from the auditors.
• If the patient is capable of signing and they refuse for any reason, “Refused” should be written in the signature area of section 1 and no other sections may be used.
• If section 2 or 3 is used on the form, the reason must correlate with assessment information in the chart.