Patient Intake Form

• Sundby, Valorie

	Patient Intake Forms (1 MB)
	DOL Disclaimer (13 KB)

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Date:

2016-07-10

Primary Material Type:

Assignment

Other Material Types:

Assignment

Institution:

Arapahoe Community College

Funding Source:

TAACCCT Round 4

Subjects:

ACC, Arapahoe Community College, Patient Intake Forms, HIT, Health Information Technology

Industry / Occupation

Industry Partner:

Valorie Sundby was in charge of the creation of these forms in PDF format and Moises Fermin was in charge of the creation of these forms in formstack

Industry Sector:

Health Care and Social Assistance (62)

Occupation:

Healthcare Practitioners and Technical Occupations -- Medical Records and Health Information Technicians (29-2071)

Education / Instructional Information

Instructional Program:

Health Professions and Related Clinical Sciences (51)

Credit Type:

• Credit

Credential Type:

• Diploma
• Certificate
• Credential
• Stacked/Latticed Credential Model
• Associate Degree

Educational Level of Materials:

• 2nd Year Community College or equivalent

Time Required:

1 hour

Language:

English (United States)

Interactivity Type:

Mix of Active and Presentation.

Quality Note:

Patient Intake Forms were created by Sundby Valorie as an exercise for Arapahoe Community College students and Moises Fermin was in charge of replicating it in formstack.

Quality of Subject Matter was assured by:

• Consultations during development of instructional materials
• Participation as an ongoing member of team developing the instructional materials

Quality of Online/Hybrid Course Design assured by:

• Quality Matters

Course Note:

Health Information Technology (Associate of Applied Science Degree)

Accessibility

Accessibility Features:

• Text Access - Text to Speech
• Text Adjust - Compatible
• Reading Layout - Page numbers match printed material
• Reading Order - Digital resource layout
• Structural Markup - Navigation Text

Copyright / Licensing

Primary License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

Additional License(s):

This work is licensed under a Creative Commons Attribution 4.0 International License.