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AUTHORIZATION TO RELEASE HEALTH CARE INFORMATION If this form is not filled out in its entirety it will result in a delay in processing. Patient Name: Previous Name: DOB: Address: Telephone Number:
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How to fill out patient name previous name
How to fill out patient name previous name:
01
Start by locating the field for "Previous Name" on the patient form.
02
If the patient has had a different name in the past, enter the previous name accurately and completely.
03
Include any maiden names, previous married names, or any other names the patient may have used in the past.
04
Make sure to double-check the spelling and accuracy of the previous name before submitting the form.
Who needs patient name previous name:
01
Healthcare providers and medical institutions: Medical professionals need the patient's previous name to maintain accurate records and avoid confusion, especially when cross-referencing different documents or medical histories.
02
Insurance companies: Insurance providers may require the patient's previous name to verify eligibility or claims, especially if the patient has changed their name due to marriage, divorce, or other reasons.
03
Legal purposes: In certain legal situations, such as providing medical records for a court case, the patient's previous name may be necessary for proper identification and documentation. This ensures that the correct individual's records are being used.
04
Research and statistics: Researchers or medical organizations conducting studies or analyzing healthcare data might require the patient's previous name for analysis, reporting, or data tracking purposes.
Remember, accurately providing the patient's previous name is essential to ensure proper identification and avoid any potential confusion or errors in healthcare and administrative processes.
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What is patient name previous name?
Patient name previous name refers to the name that a patient used before their current name.
Who is required to file patient name previous name?
Healthcare providers and facilities are required to include the patient name previous name in the patient's records.
How to fill out patient name previous name?
Patient name previous name should be filled out by including any previous names the patient has used.
What is the purpose of patient name previous name?
The purpose of including patient name previous name is to have a comprehensive record of the patient's identifying information.
What information must be reported on patient name previous name?
The patient name previous name should include all previous names the patient has used.
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