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I. STATE/LOCAL USE ONLY Phone No.: (Patient's Name:) (Last, First, M.I.) Address: City: County: ADULT HIV/AIDS CONFIDENTIAL CASE REPORT U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease
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Start by locating the section that requires the patient's name on the form or document.
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Patients name - public is the name of the individual receiving medical treatment or services that is available to the public.
Healthcare providers, hospitals, clinics, and other medical facilities are required to file patients name - public.
Patients name - public should be accurately filled out on medical records and other documentation using the individual's legal name.
The purpose of patients name - public is to identify and track medical records and information related to the individual receiving treatment.
The information reported on patients name - public includes the individual's full legal name, date of birth, and any other identifying information.
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