Get the free MINOR PATIENT REGISTRATION FORM Ver 42114
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10117 NE 58th St Ste 200, Kirkland, WA 98033 ×425× 821 6363 Faxes (425× 8214804 Lake Washington Dermatology MINOR PATIENT REGISTRATION FORM Very 4×21/14 THIS FORM IS FOR PATIENTS UNDER 18 OR STILL
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How to fill out minor patient registration form
How to fill out a minor patient registration form:
01
Start by entering the minor's personal information, such as their full name, date of birth, and gender.
02
Provide the contact information for the minor, including the parent or guardian's name, phone number, and email address.
03
Indicate the minor's primary care physician, if applicable, by entering their name and contact information.
04
Next, specify any allergies or medical conditions that the minor has, if known.
05
Provide information about the minor's medical history, including any previous surgeries or hospitalizations.
06
If the minor is currently taking any medications, include the names and dosages in the appropriate section.
07
Make sure to fill out the insurance information section accurately, including the name of the insurance provider, policy number, and any necessary contact information.
08
If the minor has any special needs or accommodations, make a note of them in the appropriate section.
09
Lastly, sign and date the form to confirm that the information provided is accurate and complete.
Who needs a minor patient registration form:
01
Healthcare providers and medical facilities require a minor patient registration form to gather important information about the minor and their medical history.
02
Parents or guardians of a minor patient may need to fill out this form when bringing their child to a new healthcare provider or when registering for a specific medical service.
03
School or sports organizations may also request a minor patient registration form to ensure they have necessary medical information on file in case of emergency or for participation in certain activities.
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What is minor patient registration form?
The minor patient registration form is a document used to collect information about patients under the age of 18.
Who is required to file minor patient registration form?
Parents or legal guardians of minor patients are required to file the minor patient registration form.
How to fill out minor patient registration form?
To fill out the minor patient registration form, parents or legal guardians must provide their contact information, the minor patient's personal details, and medical history.
What is the purpose of minor patient registration form?
The purpose of the minor patient registration form is to ensure that healthcare providers have accurate and up-to-date information about minor patients.
What information must be reported on minor patient registration form?
The minor patient registration form must include the minor patient's name, date of birth, address, emergency contacts, and any known medical conditions or allergies.
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