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Patient Name: Patient Former Name or Alias: Patient Address: Penobscot Community Health Care Medical Records Date of Birth: P.O. Box 439 Bangor, ME 044020439 (207) 4048101 Fax (207) 9901248 Patient
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How to fill out patient former name?
01
Start by locating the section on the form that requests the patient's former name. This is usually found in the personal information section.
02
In the designated space, write the patient's former name exactly as it was previously used. This may include their maiden name, previous surname, or any other name they used before.
03
If the patient has never had a different name, leave this section blank or write "N/A" to indicate that there is no former name.
Who needs patient former name?
01
Medical professionals: Doctors, nurses, and other healthcare providers may need the patient's former name to accurately update their medical records or to access information from previous medical histories.
02
Insurance companies: If the patient is filing a claim or applying for insurance, the former name may be needed for identification purposes or to match records in their database.
03
Legal entities: In some legal cases or paperwork, the patient's former name may be required to verify identity or resolve any legal matters.
It is important to provide the patient's former name accurately and honestly to ensure proper identification and avoid any complications in medical or legal processes.
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