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E. YOUR RIGHTS REGARDING YOUR IIHI You have the following rights regarding the IIHI that we maintain about you 1. Dekalbsurgical.com DeKalb Surgical Associates P. C. Notice of Privacy Practices Revised 03/01/2013 As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 HIPAA THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU AS A PATIENT OF THIS PRACTICE MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR...
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Start by entering your full name in the designated space on the form.
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Provide your contact information, including your phone number, address, and email address.
03
Indicate your date of birth and gender.
04
Fill in your social security number or any other identification number requested.
05
Specify your primary healthcare provider or doctor's name and contact information.
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Mention any allergies or medical conditions that are relevant to your health.
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Provide a detailed medical history, including any previous illnesses, surgeries, or treatments you have undergone.
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Include information about any medications you are currently taking, including dosage and frequency.
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Answer questions regarding your lifestyle habits, such as smoking, alcohol consumption, and exercise routine.
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Patient info sheet 11 is typically required by healthcare facilities, such as hospitals, clinics, and doctor's offices. It is used to gather essential information about patients for administrative and medical purposes. All individuals seeking medical care or treatment are usually required to fill out this form to ensure accurate record-keeping and provide healthcare professionals with necessary information to deliver appropriate care.
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Patient info sheet 11 is a document that contains important medical information about a patient.
Healthcare providers or medical facilities are required to file patient info sheet 11.
Patient info sheet 11 can be filled out by providing accurate and detailed medical information about the patient.
The purpose of patient info sheet 11 is to ensure that healthcare providers have access to important medical information about a patient when needed.
Patient info sheet 11 must include information such as medical history, current medications, allergies, and emergency contact information.
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