American College of Physicians | Internal Medicine | ACP
Abnormal Results Contact Attempt Record
Please note: All attempts to contact a patient must be recorded in the patient’s individual medical record at the time of the contact. This is a legal safeguard. Practice staff MUST NOT give out test results to patients unless expressly advised to by the PCP
|Patient’s Name | | | | |
|DOB | | | | |
|Patient’s Physical | | | | |
|Initials | | | | |
|Urgency of consult | | | | |
|Type of test, e.g. blood, | | | | |
|pap | | | | |
|Time, date, phone no. & | | | | |
|staff initials of 1st phone | | | | |
|call | | | | |
|Time, date, phone no. & | | | | |
|staff initials of 2nd phone | | | | |
|call | | | | |
|Time, date, phone no. & | | | | |
|staff initials of 3rd phone | | | | |
|call | | | | |
|Date 1st letter sent | | | | |
|Mail returned? | | | | |
|Date 2nd letter sent | | | | |
|Mail returned? | | | | |
|Date Registered Mail | | | | |
|Sent | | | | |
|Post office confirmation | | | | |
|received receipt | | | | |
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