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DATE: PATIENT NAME AND ADDRESS: SHIRIN PEDIATRICS 145 KILL ROAD KINGSTON, NEW YORK 12401 TEL: (845) 3601760 FAX: (845) 3609258 BIRTH DATE: PETER O'Connor M.D. TAX ID # 191817346 HOME Phones: () WORK

How to fill out 2000 12-09 sawkill pediatrics

How to fill out 2000 12-09 Sawkill Pediatrics:

1. Start by gathering all the necessary information required to fill out the form. This may include personal details of the patient, such as their name, date of birth, address, and contact information.
2. Carefully read the instructions provided on the form to understand the specific requirements and sections that need to be filled out. Pay attention to any special instructions or additional documents that may be needed.
3. Begin by filling out the patient's personal information accurately and legibly. Double-check the spellings and ensure that all information is up-to-date.
4. Proceed to provide details about the reason for the visit or medical condition. This could include symptoms, previous diagnoses, or any relevant medical history that would assist the healthcare provider.
5. If required, provide insurance information, including the policy number, coverage details, and any necessary authorizations.
6. Complete any additional sections or questions that are specific to the Sawkill Pediatrics clinic or the purpose of the form. This may involve providing consent for treatment, signing waivers, or indicating preferred methods of communication.
7. Review the completed form thoroughly to ensure all information is accurately filled out, and there are no errors or omissions. Make sure all required fields are completed and any necessary supporting documents are attached.
8. If applicable, make a copy of the filled-out form for your own records before submitting it to the Sawkill Pediatrics clinic.

Who needs 2000 12-09 Sawkill Pediatrics:

1. Patients seeking medical care for pediatric services at the Sawkill Pediatrics clinic would need the 2000 12-09 Sawkill Pediatrics form. This could include parents or legal guardians filling out the form on behalf of their child.
2. Healthcare providers at Sawkill Pediatrics may also require this form when a patient arrives for a scheduled appointment or seeks specialized pediatric services.
3. The form is essential for maintaining accurate patient records and facilitating smooth communication between the patient, healthcare providers, and the clinic.

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What is 12-09 sawkill pediatrics?

12-09 Sawkill Pediatrics is a form used for reporting pediatric health information.

Who is required to file 12-09 sawkill pediatrics?

Healthcare providers, specifically pediatricians, are required to file the 12-09 Sawkill Pediatrics form.

How to fill out 12-09 sawkill pediatrics?

The 12-09 Sawkill Pediatrics form can be filled out by providing all required pediatric health information in the designated sections.

What is the purpose of 12-09 sawkill pediatrics?

The purpose of 12-09 Sawkill Pediatrics is to track and monitor the health status of pediatric patients.

What information must be reported on 12-09 sawkill pediatrics?

Information such as patient demographics, medical history, current medications, and any diagnoses must be reported on the 12-09 Sawkill Pediatrics form.