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Edward T. Shin, M.D., D.A.B.P.M. Comprehensive Pain Management American Society of Anesthesiology/ American Board of Pain Medicine Office) 9727810300 Fax) 9727810301 INFORMATION DEL PATIENTS Information
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How to fill out informacion del paciente
How to fill out informacion del paciente:
01
Start by providing the patient's full name, including their first name, middle name (if applicable), and last name.
02
Indicate the patient's date of birth, including the day, month, and year.
03
Specify the patient's gender, whether they are male or female.
04
Include the patient's contact information, such as their phone number and email address.
05
Provide the patient's address, including the street name and number, city, state, and ZIP code.
06
Mention any relevant identification numbers, such as the patient's social security number or driver's license number.
07
Indicate the patient's primary language, as well as any other languages they may speak fluently.
08
Include the patient's emergency contact information, including the name, relationship, and phone number of the person to be contacted in case of an emergency.
09
Specify the patient's medical history, including any known allergies, chronic conditions, or previous surgeries.
10
Provide details about the patient's insurance information, including the name of the insurance company, policy number, and group number.
11
Mention any additional information that may be relevant for the patient's treatment or medical records.
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