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Microsoft Word NEW PATIENT FACE SHEET.doc Created Date: 6/24/2014 6:56:09 PM ...
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How to fill out new patient general information
01
To fill out new patient general information, gather and provide the necessary personal details such as full name, address, phone number, date of birth, and social security number.
02
Next, include your insurance information, if applicable. This may include the name of your insurance company, policy number, group number, and any primary or secondary coverage details.
03
In the section for medical history, carefully note any current or past medical conditions, surgeries, allergies, and medications you are currently taking. It is essential to be as thorough and accurate as possible to ensure proper medical care.
04
Provide information about your primary care physician or referring doctor, including their name, contact information, and any relevant medical records or referral documents.
05
Include emergency contact details, including the name, relationship, and phone number of someone who can be contacted in case of an emergency.
06
If you have specific preferences or requirements, such as language preferences, disability accommodations, or religious considerations, make sure to include them in the appropriate section.
07
Finally, sign and date the form to indicate your consent and acknowledgment of the provided information.
Who needs new patient general information?
01
Any individual who is visiting a healthcare facility or provider for the first time needs to provide new patient general information.
02
This information is required by medical professionals to create an accurate and comprehensive medical record for the patient.
03
New patient general information is important for both the patient and the healthcare provider, as it helps ensure that appropriate medical care can be delivered effectively.
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