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Geriatric Center 8050 Highway 191, Ste. 204 Odessa, TX 79765 Authorization to Release and Disclose Patient Information TTU HSC MAN: PATIENT NAME: DATE OF BIRTH: Address: Day Phone: City: State: Zip:
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Start by gathering all necessary personal information such as full name, date of birth, address, and contact information.
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Provide details about the patient's medical history, including any chronic conditions, previous surgeries or hospitalizations, and current medications.
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Specify the reason for seeking care at the geriatric center, such as a specific health concern or the need for specialized geriatric services.
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Indicate any specific preferences or requests, such as the desired primary care physician or any special accommodations needed during the appointment.
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Older adults who require comprehensive medical care tailored to their specific needs, as geriatric centers like ttuhsc specialize in providing care for the aging population.
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Those looking for a multidisciplinary approach to their healthcare, with access to a team of geriatric specialists including physicians, nurses, occupational therapists, pharmacists, and social workers.
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The geriatric center - ttuhsc is a facility that specializes in providing care for elderly patients.
The administration or management of the geriatric center - ttuhsc is required to file the necessary documents.
To fill out the geriatric center - ttuhsc form, you must provide all relevant information regarding the facility's operations and patient care.
The purpose of the geriatric center - ttuhsc is to ensure that elderly patients receive comprehensive and quality care tailored to their needs.
The geriatric center - ttuhsc form must include details on patient demographics, services provided, staffing levels, and any incidents or complaints.
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