📅 Missed Appointments (No-Show), Late Arrivals & Same-Day Cancellations

To establish a consistent process for managing missed appointments, late arrivals, and same-day cancellations while promoting patient access, provider efficiency, and continuity of care.

Purpose

Missed appointments reduce appointment availability, delay patient care, and negatively affect clinic efficiency. This policy provides a standardized workflow for documenting no-shows, communicating with patients, and rescheduling care when appropriate.

Policy

All missed appointments, late arrivals, and same-day cancellations must be documented in RXNT. Staff will make reasonable efforts to contact patients, encourage rescheduling, and document all communication attempts according to clinic policy.

No-Show Workflow

1️⃣ Mark Appointment as No-Show
2️⃣ Document in RXNT
3️⃣ Attempt Patient Contact
4️⃣ Send Portal Message
5️⃣ Offer Rescheduling
6️⃣ Complete Documentation

Appointment Definitions

No-Show

  • Patient does not arrive for the scheduled appointment.
  • No advance notice is provided.
  • Appointment is documented as a no-show in RXNT.

Late Arrival

  • Patient arrives after the scheduled appointment time.
  • Provider determines whether the patient can still be seen.
  • Rescheduling may be necessary based on clinic workflow.

Same-Day Cancellation

  • Patient cancels on the day of the appointment.
  • Reason for cancellation is documented.
  • Offer the next available appointment when appropriate.

Front Office Responsibilities

  • Document missed appointments immediately in RXNT.
  • Attempt to contact the patient by telephone.
  • If unable to reach the patient, continue outreach according to clinic communication standards.
  • Send a secure patient portal message when appropriate.
  • Offer rescheduling during patient contact.
  • Notify clinical staff if repeated no-shows affect patient care.
  • Document every communication attempt.

Best Practice

Whenever possible, contact the patient on the same business day as the missed appointment. Early outreach improves rescheduling rates and helps identify barriers that may prevent patients from receiving care.

Immediate Escalation Required

  • Repeated missed appointments involving high-risk patients.
  • Missed follow-up after hospital discharge.
  • Failure to follow up on critical laboratory or diagnostic results.
  • Behavioral health patients with safety concerns.
  • Provider requests additional outreach.
  • Concerns regarding patient welfare or neglect.

Patient Outreach Process

When a patient misses an appointment, timely communication helps identify barriers to care, improves continuity, and provides an opportunity to reschedule. All outreach attempts must be documented in RXNT.

📞 1st Phone Call
📞 2nd Phone Call
📞 3rd Phone Call
💬 Send RXNT Portal Message
📅 Offer Rescheduling
📝 Document & Close
TNC Standard

The Neighborhood Clinic follows a standardized outreach process of three documented phone call attempts, followed by a secure RXNT Patient Portal message when available. Every communication attempt must be documented in the patient's medical record.

Patient Communication Guidelines

Staff should communicate professionally and supportively while encouraging patients to continue their care.

  • Verify patient identity before discussing protected health information.
  • Express concern for the missed appointment.
  • Offer the next available appointment.
  • Ask if transportation, financial, or scheduling barriers exist.
  • Provide the clinic phone number for return calls.
  • Avoid judgmental or punitive language.

Best Practice

Every missed appointment is an opportunity to reconnect the patient with care. Conversations should focus on helping patients receive the care they need while maintaining a welcoming and respectful experience.

Repeat No-Show Process

Patients with repeated missed appointments may require additional provider review to ensure appropriate continuity of care.

  • Document every missed appointment in RXNT.
  • Continue outreach using the standard communication process.
  • Notify the provider of repeated no-show patterns.
  • Review for high-risk medical conditions or outstanding care needs.
  • Follow provider recommendations regarding future scheduling.
  • Escalate concerns to leadership when repeated no-shows affect patient safety or clinic operations.

Escalate Immediately If:

  • The patient has outstanding critical laboratory or imaging results.
  • The patient recently experienced hospitalization or an Emergency Department visit.
  • The patient is considered high risk by the provider.
  • The missed appointment involves urgent follow-up care.
  • Behavioral health safety concerns are identified.
  • The provider requests additional outreach.

Late Arrival Management

Patients arriving after their scheduled appointment time will be managed based on provider availability and clinic workflow.

  • Notify the provider immediately of the patient's arrival.
  • The provider will determine whether the patient can still be seen.
  • If rescheduling is necessary, offer the earliest appropriate appointment.
  • Document the late arrival and final disposition in RXNT.
  • Communicate expectations respectfully and consistently.

Documentation Requirements

  • Date and time of the missed appointment.
  • Appointment type.
  • No-show, late arrival, or same-day cancellation status.
  • Reason provided by the patient, if available.
  • Date and time of each phone call attempt.
  • Documentation of the RXNT Patient Portal message.
  • Rescheduling outcome.
  • Provider notification when applicable.
  • Additional follow-up actions completed.
  • Final disposition documented in RXNT.
Documentation should provide a complete record of patient communication, outreach efforts, and scheduling actions. Every communication attempt should be recorded objectively and promptly.

Quality Assurance

Front Office

  • Document missed appointments promptly.
  • Complete all outreach attempts.
  • Offer rescheduling.
  • Maintain accurate scheduling records.
  • Notify providers when indicated.

Clinical Team

  • Review repeated no-show patterns.
  • Determine follow-up urgency.
  • Identify patients requiring additional outreach.
  • Provide recommendations for continued care.
  • Support continuity of care.

Leadership

  • Monitor clinic no-show rates.
  • Audit documentation for compliance.
  • Review scheduling efficiency.
  • Identify opportunities to reduce missed appointments.
  • Provide ongoing staff education.

Missed Appointment Checklist

✅ Mark appointment status correctly in RXNT
✅ Document the missed appointment
✅ Complete Phone Call Attempt #1
✅ Complete Phone Call Attempt #2
✅ Complete Phone Call Attempt #3
✅ Send a secure RXNT Patient Portal message
✅ Offer the next available appointment
✅ Notify the provider when appropriate
✅ Document all communication attempts
✅ Complete final documentation in RXNT

Sawubona Standard

A missed appointment should never be viewed as simply an empty time slot. It represents a patient whose healthcare needs may still exist. By proactively reaching out, identifying barriers to care, and welcoming patients back without judgment, The Neighborhood Clinic demonstrates its commitment to compassion, accessibility, and continuity of care. Every outreach effort reflects our belief that every patient deserves another opportunity to be seen, heard, and cared for.