Final answer:
The ABN form includes the patient's name, healthcare provider's name, date of service, and type of service. It is used to inform Medicare beneficiaries about services that may not be covered by Medicare.
Step-by-step explanation:
The ABN form, which stands for Advanced Beneficiary Notice, is a form used in healthcare to inform Medicare beneficiaries that a specific service may not be covered by Medicare.
The ABN form includes several important pieces of information, including the patient's name, healthcare provider's name, date of service, and type of service.
This form is necessary to help patients make informed decisions about their healthcare and to protect them from potential financial liability.