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Thomas L. Horowitz, D.O. 1245 Wilshire Boulevard, Suite 310 Los Angeles, CA 900174803 T 2134822065 F 2134820215 www.thomashorowitz.com PATIENT REGISTRATION FORM Name Male Female Single Married Widowed

How to fill out patientregistration formdoc

1. Start by obtaining a patient registration formdoc from the healthcare provider or clinic where you will be receiving medical care. This form is typically required for new patients or for existing patients who need to update their information.
2. Begin filling out the patient registration formdoc by providing your personal details such as your full name, date of birth, and contact information. Make sure to double-check the accuracy of this information as it will be used for communication and identification purposes.
3. Next, provide your insurance information if applicable. This may include your insurance provider's name, policy number, and group number. If you do not have insurance, indicate this on the form as well.
4. The patient registration formdoc may also ask for your medical history or any existing medical conditions. Be honest and thorough with your responses as this information will assist healthcare providers in offering you the appropriate care.
5. If you are taking any medications or have any known allergies, make sure to indicate this on the form. It is important for healthcare providers to be aware of any potential drug interactions or allergies that may impact your treatment.
6. Additionally, you may be asked to provide emergency contact information. This is crucial in case of an emergency or if healthcare providers need to communicate important information to someone close to you.
7. Finally, review all the information you have provided on the patient registration formdoc to ensure it is accurate and complete. If you have any questions or concerns, do not hesitate to ask a staff member at the healthcare facility for clarification.

Who needs patientregistration formdoc?

1. Individuals who are new patients at a healthcare provider or clinic and need to establish their medical records.
2. Existing patients who need to update their personal or medical information.
3. Patients who have changed insurance providers and need to provide updated insurance information.
4. Anyone receiving medical care that requires accurate and up-to-date patient information for proper diagnosis and treatment.

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