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Mercy General Hospital P.O. Box 19254 Sacramento, CA 95819-9990 (916) 453-4545 Telephone GENERAL AUTHORIZATION FOR USE AND / OR DISCLOSURE OF PROTECTED HEALTH INFORMATION (Note: Do Not Use This Form
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Start by obtaining the necessary paperwork from the hospital's admissions department.
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Fill out personal information such as name, address, contact details, and insurance information. Make sure to provide accurate and updated information.
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If applicable, provide details about your primary care physician and any authorized individuals who may have access to your medical records.
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Specify the reason for your visit or admission, including any symptoms or medical conditions you are experiencing.
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Include any specific instructions or requests regarding medications, allergies, dietary restrictions, or special accommodations.
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Sign and date the form, acknowledging that the information provided is accurate and complete.
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Submit the completed form to the admissions department or follow any specific instructions provided by the hospital.
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Patients who require specialized medical care or treatment that is offered by Mercy General Hospital.
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What is mercy general hospital?
Mercy General Hospital is a hospital located in Sacramento, California, that provides healthcare services to the community.
Who is required to file mercy general hospital?
The hospital administration or authorized personnel are required to file reports for Mercy General Hospital.
How to fill out mercy general hospital?
The reporting process for Mercy General Hospital involves providing details about the hospital's operations, finances, and patient care.
What is the purpose of mercy general hospital?
The purpose of Mercy General Hospital is to offer medical treatment, care, and support to patients in need.
What information must be reported on mercy general hospital?
Information such as patient admissions, discharges, medical procedures, financial data, and quality of care measures must be reported for Mercy General Hospital.
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