Patient Information

Next, we’ll discuss how to complete patient information on the CMS-1500 and 837P. This includes the patient’s name, address, and account number.

• Patient’s Name
• Patient’s Birth Date and Sex
• Patient’s Address and Telephone Number
• Patient’s or Authorized Person’s Signature
• Date of Current Illness, Injury, or Pregnancy, Last Menstrual Period (LMP)
• Hospitalization Dates Related to Current Services
• Patient’s Account Number