Facility Medical Record # Last 4 Of SSN Admitting State Hospitaladatc Date Time Nc Division Of Mental Healthdevelopmental Disabi
Use a Facility Medical Record # Last 4 Of SSN Admitting State HospitalADATC DATE TIME NC DIVISION OF MENTAL HEALTHDEVELOPMENTAL DISABI 2007 template to make your document workflow more streamlined.
What this facility medical record contains
This facility medical record identifies a patient using the last four digits of the Social Security number, records the admitting state, and captures the hospital or ADATC facility, admission date, and time. North Carolina Division of Mental Health, Developmental Disabilities, and Substance Use Services facilities can use these details to associate an admission with the correct care setting and authorized record. Complete each field from the facility’s source records, limit access to authorized personnel, and preserve the signed copy with its audit trail.
Who benefits from this record workflow
The form is most useful where facility staff must connect patient identifiers with an admission event and preserve authorized approvals.
North Carolina behavioral-health facilities can capture admission identifiers and authorized signatures while keeping the facility, admitting state, date, and time together in one controlled record. Hospital records departments can route completed facility records to designated reviewers, preserve the audit trail, and reduce manual handling of patient admission paperwork. Multi-site healthcare organizations can standardize the same record workflow across facilities while assigning access and signing responsibilities to appropriate staff.
These tasks are executed by both individual contributors and centralized administrators depending on organizational policy and required controls.
Complete the facility medical record
Use signNow to prepare the record, route signatures, and preserve a traceable completion file.
Upload record:
Upload the facility record PDF to signNow. Check fields:
Review detected fields for medical and admission details. Add signers:
Add authorized staff and patient signers. Send securely:
Send the completed record for electronic signatures. Store evidence:
Download the signed record and audit trail.
How the record workflow works
The signNow process follows the facility record from upload through authenticated signing and controlled storage.
Upload document: Upload the facility medical record PDF. Detect fields: signNow detects fields for review. Assign signers: Assign staff and patient signatures. Preserve evidence: Store the signed record with its audit trail.
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Recommended record workflow settings
Configure the workflow around authorized access, patient privacy, and an exportable record of every signature event.
| Setting | Recommendation |
|---|---|
| Authentication method | Email plus SMS verification |
| Signature type | Electronic signature with signer consent |
| Audit trail | Retain completion certificate and event log |
| Document retention | 6 years when HIPAA applies |
| Encryption | AES-256 at rest and TLS in transit |
Features for facility record completion
Each feature addresses a specific point in preparing, signing, protecting, or retaining this facility medical record.
Field accuracy
Keeps the last four Social Security number digits, admitting state, facility, date, and time together for clearer admission-record matching.
Field detection
Detects fillable areas after upload so staff can review and complete the facility record before routing it.
Signer routing
Routes the record to designated signers without requiring repeated paper handling between facility departments.
Audit trail
Captures timestamps, signer actions, and completion evidence for later review of the admission record.
HIPAA workflow
Supports protected healthcare workflows when the organization has the required HIPAA business associate arrangement.
Record archive
Preserves a downloadable signed record and completion evidence for the facility’s approved retention process.
Find and fill out the correct facility medical record last 4 of ssn admitting state hospitaladatc date time nc division of mental healthdevelopmental
airSlate SignNow helps you fill in and sign documents in minutes, error-free. Choose the correct version of the editable PDF form from the list and get started filling it out.
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| NC DMH 1-73-00 2014 | 4.8 Satisfied (1568 Votes) | |
| NC DMH 1-73-00 2007 | 4.8 Satisfied (132 Votes) |
Security for facility medical records
AES-256 encryption:
TLS protection:
HIPAA compliance:
SOC 2 Type II:
ISO 27001:
GDPR safeguards:
Best practices for this record
Accurate identifiers, controlled access, and a preserved audit trail reduce privacy and record-integrity problems during facility admissions.
Verify every identifying field before sending
Restrict access to authorized facility personnel
Check signature fields and admission details
Archive the signed record with evidence
Privacy pitfalls to avoid
Including a full Social Security number instead of only the last four digits unnecessarily increases exposure of sensitive patient information. Sending the record to an unapproved recipient can disclose admission details outside the facility’s authorized care or administration process. Leaving the admitting state, facility, date, or time blank can prevent reliable matching to the patient’s admission record. Failing to preserve the audit trail weakens evidence of who signed, when the record was completed, and whether it changed afterward.
What the audit trail records
The audit trail documents technical events surrounding this facility record rather than replacing the record’s medical or admission content.
Authenticate signer:
Capture timestamp:
Hash document:
Seal record:
Record events:
Export evidence:
Retention rules for related records
Apply the rule that actually governs the facility record and confirm whether North Carolina or program-specific requirements require longer retention.
Six years — HIPAA records
Three years — tax records
Six years — 25% understatement
Three years — payroll records
Thirty years — exposure records
Troubleshooting facility record completion
These answers address field detection, healthcare privacy, signer authentication, plan selection, and evidence preservation for this specific record.
Upload the facility medical record PDF again and check whether its fields are selectable. If auto-detection misses a field, add a text, date, or signature field manually before assigning the authorized signer.
The Business plan includes legally binding eSignatures, templates, audit trails, and mobile apps. Business Premium adds bulk send and kiosk mode; choose a plan based on this facility’s routing volume and signing method.
For patient information, HIPAA compliance requires a business associate arrangement. signNow identifies HIPAA compliance as requiring a BAA; confirm that the organization has the required agreement before processing protected health information.
Use signNow’s signer authentication options, such as SMS verification where configured, and verify the recipient’s identity before sending. Do not rely on an email address alone when facility policy requires stronger proof.
Download the completed document and its audit trail after all required signatures. The audit trail records signing events and supports evidence of intent, attribution, timestamps, and record preservation.
If a patient disputes an electronic signature, preserve the signed PDF, completion certificate, audit trail, consent evidence, and recipient details. ESIGN and applicable state law assess intent, consent, attribution, and reproducibility.
Key performance indicators that demonstrate SignNow's proven track record.
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