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Patient Authorization to Disclose Health Information Patient Name: I authorize: Date of Birth: MidColumbia Medical Center TH 1700 E. 19 Street The Dallas, OR 97058 Fax: (541) 2967617 Information may
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Gather all necessary personal information such as name, address, date of birth, and contact details.
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Determine the reason for your visit - whether it is for general check-up, specific medical condition, or a scheduled procedure.
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Call MidColumbia Medical Center to schedule an appointment based on the nature of your healthcare needs.
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Arrive at MidColumbia Medical Center at least 15 minutes before your scheduled appointment time.
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Upon arrival, check-in at the front desk and provide them with your personal and insurance information, if applicable.
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Follow any instructions provided by the medical staff, such as completing additional paperwork or providing a urine or blood sample.
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Wait for your name to be called or receive instructions on where to go for your consultation or procedure.
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Engage actively with the healthcare professionals at MidColumbia Medical Center, providing accurate and detailed information about your symptoms, concerns, and medical history.
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Individuals who require medical care for general check-ups, acute illnesses, or chronic conditions.
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Mid-Columbia Medical Center is a regional hospital located in The Dalles, Oregon.
Anyone who has received medical services or treatment at Mid-Columbia Medical Center may be required to file a report.
Fill out the appropriate forms provided by Mid-Columbia Medical Center with accurate and detailed information about the medical services received.
The purpose of Mid-Columbia Medical Center is to provide quality healthcare services to the community.
Information such as patient demographics, medical services provided, diagnosis, and billing information must be reported on Mid-Columbia Medical Center forms.
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