ACHS OnCall
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Reach the on-call hand surgeon. All fields with * are required.
Patient Name *
MRN
DOB *
Callback Phone *
Ext
Insurance *
Select payer…
Aetna
AHCCCS / AZ Medicaid
Blue Cross Blue Shield
Cigna
Humana
Medicare
Tricare
UnitedHealthcare
Workers' Comp
Self-Pay / Uninsured
Unknown
Other (specify)
Insurance (specify)
Room #
Service *
Hand Surgery
Plastic Surgery
Hospital *
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Diagnosis / Reason
Details / Question
Patient personal cell
Your Name (caller) *
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