Miami Pediatric Center of Excellence Patient Information free printable template

Com pediatricexcellence. com Dr. Liat Corcia Pediatric Endocrinologist Miami Pediatric Endocrinology LLC PATIENT INFORMATION Patient s Name Date of Birth // Sex Male / Female Address Zip Code Home Phone - E-mail Address Preferred Phone - Preferred Language Spanish or English Referring Physician How did you hear about our Practice PARENT / LEGAL GUARDIAN INFORMATION Name Address Cell Phone - Relationship INSURANCE INFORMATION Plan Name I. 4425 Ponce de Leon Blvd. Suite 115 Coral Gables FL...

How to fill out pediatricexcellence yes miami make form

How to fill out Miami Pediatric Center of Excellence Patient Information

1. Visit the Miami Pediatric Center of Excellence website or obtain a physical copy of the Patient Information form.
2. Begin by filling out the patient's personal information, including full name, date of birth, and sex.
3. Provide contact information for the parent or guardian, including their name, relationship to the patient, phone number, and email address.
4. Fill in the patient's insurance information, if applicable, including the insurance provider, policy number, and any necessary subscriber details.
5. Complete the medical history section, noting any past illnesses, surgeries, or ongoing treatments.
6. List any allergies or medications the patient is currently taking.
7. Answer any additional questions about the patient's family medical history as prompted on the form.
8. Review the completed form for accuracy and sign where required.
9. Submit the form either online or in person at the Miami Pediatric Center of Excellence.

Who needs Miami Pediatric Center of Excellence Patient Information?

1. Parents or guardians of children who are patients at the Miami Pediatric Center of Excellence.
2. New patients seeking to establish care with the facility.
3. Existing patients who are updating their information or re-registering for services.

Video instructions and help with filling out and completing miami pediatric excellence form sample

Instructions and Help about pediatricexcellence yes miami fillable

Music my name is Kelly Silver, and I am a pediatric endocrinologist with Nicholas Children's Hospital by the time I was in middle school I was certain I was going to be a pediatric ophthalmologist but as time went by my experiences changed my dad developed diabetes when I was in high school and I remember in medical school because of his experience and what he went through that I invested more time learning about diabetes and other hormone issues, and it was after that I knew pediatric endocrinology was the right fit for me my clinical interests are general within the scope of endocrinology and I love treating kids who have various hormone issues whether they have growth problems puberty problems thyroid problems or diabetes I am excited to be working at Nicholas Children's Hospital it's a name that is known it's a name that is recognized nationally, and it's a name that is trusted the pediatric endocrinology program is consistently ranked among the best by US News and World Report the most exciting thing about being part of Nicholas Children's Hospital is their expansion to areas where pediatric specialty care is limited or even unavailable were bringing health care to the children and health care to their communities were becoming a part of their community Music

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What is Miami Pediatric Center of Excellence Patient Information?

The Miami Pediatric Center of Excellence Patient Information is a comprehensive document that collects essential details about a patient's medical history, demographic information, and health care needs to ensure effective treatment and management.

Who is required to file Miami Pediatric Center of Excellence Patient Information?

Parents or legal guardians of pediatric patients are required to file the Miami Pediatric Center of Excellence Patient Information.

How to fill out Miami Pediatric Center of Excellence Patient Information?

To fill out the Miami Pediatric Center of Excellence Patient Information, individuals should carefully enter personal details including the child's name, date of birth, medical history, current medications, and insurance information as instructed on the form.

What is the purpose of Miami Pediatric Center of Excellence Patient Information?

The purpose of the Miami Pediatric Center of Excellence Patient Information is to gather and maintain accurate health records to facilitate tailored healthcare services for pediatric patients.

What information must be reported on Miami Pediatric Center of Excellence Patient Information?

The information that must be reported includes the patient's name, date of birth, contact information, medical history, allergies, current medications, and insurance details.