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Rome Lane Pediatric Group, Inc. 610 E. Rome Lane, Suite 2 Salinas, CA 93901 Phone: 8314229001 Fax: 8314220577 Name of Patient: Date of Birth: Acknowledgement of Receipt of Notice of Privacy Practices
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Visit the Romie Lane Pediatric Group website or office to obtain the necessary forms.
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Begin by filling out your personal information, including your full name, contact information, and date of birth.
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Provide details about your child, including their name, date of birth, and any medical conditions or allergies they may have.
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Indicate your preferred method of payment and provide any insurance information if applicable.
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Fill out the medical history section accurately, providing information about any previous illnesses, surgeries, or medications your child has had.
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If your child is currently under the care of another healthcare provider, provide their contact information and any relevant medical records.
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Sign and date the forms where indicated, acknowledging that the information provided is true and accurate.
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Submit the completed forms to the Romie Lane Pediatric Group either online or in person.

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Parents or caregivers seeking medical care for their children from qualified pediatricians.
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Individuals who want their child to receive personalized and specialized care from a pediatric-focused medical practice.
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Romie Lane Pediatric Group is a pediatric medical practice located on Romie Lane.
The physicians and healthcare providers working at Romie Lane Pediatric Group are required to file.
To fill out Romie Lane Pediatric Group, the physicians and healthcare providers need to report patient information, medical treatments, and billing details.
The purpose of Romie Lane Pediatric Group is to provide medical care to pediatric patients in the community.
Patient demographics, medical history, treatment plans, and billing information must be reported on Romie Lane Pediatric Group.
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