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Portland Natural Medicine 516 SE Morrison St., Ste.207, Portland, OR 97214 pH: (503) 239-1022 Fax: (503) 512-5850 PATIENT PREFERRED CONTACT FORM Name Last First M.I. Date of Birth Address Street City
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How to fill out Portland Natural Medicine 516:

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Start by accessing the Portland Natural Medicine website or contacting their office to obtain the correct form.
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Read the instructions provided with the form carefully to understand the requirements and guidelines for completing the document.
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Begin by entering your personal information, such as your name, address, phone number, and email address in the designated fields.
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Provide any additional details requested, such as your date of birth, gender, and emergency contact information.
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If applicable, indicate your insurance information, including the name of your insurance provider and policy number.
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Proceed to complete the medical history section, including any pre-existing conditions, allergies, medications you are currently taking, and previous surgeries or treatments.
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In the next section, disclose any family medical history that may be relevant, such as a history of certain diseases or conditions.
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If desired, you can also provide information about your lifestyle habits, such as exercise routines, dietary preferences, and stress levels.
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Ensure that you review the completed form for accuracy and completeness before submitting it. Consider seeking assistance from a medical professional or staff member if you have any questions or concerns about specific sections.
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Once you are satisfied with the form, follow the instructions provided by Portland Natural Medicine to submit the completed document. It may involve mailing or hand-delivering the form to their office or submitting it electronically through their website or designated online portal.

Who needs Portland Natural Medicine 516?

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Individuals seeking healthcare services from Portland Natural Medicine may need to complete the Portland Natural Medicine 516 form.
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Patients who are new to Portland Natural Medicine or have not filled out this form before may be required to do so in order to establish their medical records.
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Portland Natural Medicine 516 is a form for reporting health care services provided by naturopathic physicians in Portland.
Naturopathic physicians in Portland are required to file Portland Natural Medicine 516.
Portland Natural Medicine 516 can be filled out online or submitted in paper form with all required information.
The purpose of Portland Natural Medicine 516 is to track and report health care services provided by naturopathic physicians in Portland.
Portland Natural Medicine 516 requires reporting of patient demographics, diagnoses, treatments, and fees.
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