Riverside Family Medicine • Wilmington
Pre-Visit Intake
LM
Pre-Visit Intake
Review forms, insurance readiness, and check-in exceptions for an appointment.
Tuesday, September 29, 2026
Pre-Visit Intake • AP-29481
Emma Lewis
New patient • Annual physical • Today at 2:00 PM • Dr. Sarah Wilson
Overall readiness80% complete
InsuranceCard image missing
EligibilityActive
ArrivalExpected in 34 min
Intake Forms
Digital forms associated with today’s appointment
Demographics
Address1845 Oak Ridge Dr, Wilmington, DE 19808
Phone(302) 555-0187
Emailemma.lewis@example.com
Emergency contactMichael Lewis • Spouse
✓Completed
Medical History
Current medicationsNone reported
AllergiesPenicillin
Past conditionsSeasonal allergies
Family historyHypertension
✓Completed
Consent & Acknowledgements
Consent for TreatmentSigned Sep 29, 2026
SignedPrivacy Practices AcknowledgementSigned Sep 29, 2026
SignedInsurance VerificationAetna PPO • Primary
Eligible✓
Member ID validated
AET-4428917
✓
Coverage active
Effective Jan 1, 2026
Insurance card image
Missing — front desk action required
Check-In Readiness
What must be resolved before rooming
✓
Identity information
Complete
✓
Medical history
Complete
✓
Consent forms
Signed
Insurance card
Capture at front desk
Front desk exception
Insurance eligibility is active, but the patient has not uploaded a card image. Capture the card during arrival before rooming.