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COASTAL SURGERY SPECIALISTS PATIENT INFORMATION (PLEASE PRINT AND FILL OUT ENTIRE FORM.) PATIENT INFORMATION LAST NAME MALE FEMALE * * FIRST NAME SOCIAL SECURITY NUMBER * * PRIMARY LANGUAGE RACE ETHNICITY

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1. Start by opening the new pt forms combineddoc file on your computer.
2. Review the information requested on the forms, such as personal details, medical history, and contact information.
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4. Fill in your date of birth, gender, and any other identifying information that is required.
5. Move on to the section asking for your medical history. Provide details about any previous illnesses, surgeries, or chronic conditions you may have.
6. If applicable, provide information about your current medications, including dosages and frequency.
7. Ensure that you accurately fill in your contact information, including your phone number, address, and emergency contact details.
8. Next, carefully read any consent forms included and sign them if necessary.
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10. Save a copy of the completed forms for your records and submit them as instructed.

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1. New patients visiting a healthcare facility or medical practice are usually required to fill out new pt forms combineddoc.
2. These forms are necessary to gather essential information about the patient, including personal details, medical history, and contact information.
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