Get the free Adult Established Patient Packet 2-2015 - Wake Psychiatry
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ADULT ESTABLISHED PATIENT PACKET PATIENT INFORMATION DOCTOR: DATE: / / DOB: / / SS # NAME: (last) (first) (middle) ADDRESS: CITY: STATE: ZIP: PHONE (HOME): (CELL): EMAIL: GENDER: M F Marital Status
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How to fill out adult established patient packet
How to fill out adult established patient packet:
01
Start by gathering all necessary personal information such as full name, date of birth, social security number, and contact information.
02
Next, provide information about your insurance coverage. This includes your insurance provider, policy number, and any relevant information regarding your coverage.
03
Fill out the medical history section thoroughly. Be sure to disclose any existing medical conditions, surgeries, allergies, and any medications you are currently taking.
04
Complete the section pertaining to family medical history. Provide details about any hereditary conditions or diseases that may run in your family.
05
If applicable, provide information about your primary care physician and any specialists you are currently seeing.
06
Indicate if you have any specific healthcare preferences or limitations.
07
Finally, sign and date the form to acknowledge that you have provided accurate information.
Who needs adult established patient packet:
01
New adult patients who are seeking medical care from a particular healthcare provider or facility are typically required to fill out an adult established patient packet.
02
Existing patients may also be asked to update their information by filling out this packet periodically.
03
The packet is necessary to ensure that healthcare providers have accurate and up-to-date information about their patients, helping them deliver the best possible care.
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