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PATIENT QUESTIONNAIRE LARRY Z. LOCKEAN, DDS Patients name: Date of birth / / Residence Address: home phone #() City, State Zip: S.S.#: Business Phone: Cell Phone: Patients Employer (or parents): Phone:
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Start by gathering the necessary documents, such as the patient's identification and insurance cards.
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Begin filling out the patient's basic information, including their full name, date of birth, address, and contact details.
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Who needs patient information - Larry?
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Medical professionals: Doctors, nurses, and other healthcare providers need patient information to assess the patient's health, make informed decisions, and provide appropriate treatment.
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Insurance companies: Patient information is necessary for insurance companies to process claims and determine coverage.
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Researchers: Patient information may be used for medical research purposes, but this should always be done while maintaining patient confidentiality and privacy.
Remember, it is essential to handle patient information with the utmost confidentiality and follow all applicable privacy laws and regulations.
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