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Deceased Full Name: Date of Birth: FAC Medical Record Number: Pathology & Laboratory Medicine PERMISSION FOR AUTOPSY REPORT OF DEATH Service: Attending Physician (Print full name): Referring Physician
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How to Fill Out Fletcher Allen Health Care:

01
Begin by gathering all necessary personal information such as name, date of birth, address, and contact information. This information will be required to accurately identify and register the individual seeking healthcare services.
02
Next, ensure you have any relevant insurance information readily available. This may include policy numbers, group numbers, and contact information for the insurance provider. This will aid in coordinating coverage and billing for any services provided.
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Proceed to the Fletcher Allen Health Care website or visit the facility in person to locate the appropriate forms. Often, healthcare providers have specific forms for new patients or individuals seeking to update their information. These forms may be available for download or may need to be filled out on-site.
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Carefully read and complete each section of the form, providing accurate and up-to-date information. Be sure to follow any instructions provided, such as providing a signature in specific areas or providing additional documentation if required.
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If you encounter any questions or sections on the form that you are unsure of, it is recommended to seek assistance from the Fletcher Allen Health Care staff or contact their customer service for guidance. They will be able to provide any necessary clarification or assistance in completing the form accurately.
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Once all sections of the form are completed to the best of your knowledge, review it one final time to ensure all information is accurate and legible. Making any necessary corrections or adjustments at this stage will help prevent any potential delays or issues with your healthcare services.

Who Needs Fletcher Allen Health Care:

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Individuals seeking comprehensive healthcare: Fletcher Allen Health Care is designed to cater to a wide range of healthcare needs, providing services such as primary care, specialty care, surgical procedures, and emergency care. Those in need of medical attention or preventive care will find the healthcare services at Fletcher Allen beneficial.
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Individuals residing in the Burlington, Vermont area: Fletcher Allen Health Care is a renowned medical center located in Burlington, Vermont. Therefore, individuals residing in this area or nearby communities can conveniently access and benefit from the quality healthcare services offered by Fletcher Allen.
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Patients requiring specialized care: Fletcher Allen Health Care is equipped with state-of-the-art facilities and a team of highly trained medical professionals. This makes it an ideal choice for individuals requiring specialized care, including complex surgeries, advanced diagnostics, and specialized treatment plans.
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Those with health insurance coverage: While Fletcher Allen Health Care accommodates patients with and without insurance coverage, having health insurance can facilitate coordination of payment and billing processes. Those with insurance coverage can maximize their benefits and receive comprehensive care within the network of Fletcher Allen's affiliated providers.
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Individuals looking for a patient-centered approach: Fletcher Allen Health Care focuses on patient-centered care and strives to provide a compassionate and personalized experience to each patient. Those who value a healthcare provider that prioritizes the individual's needs and preferences will find Fletcher Allen Health Care to be a suitable choice.
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