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TENURE/HAROLD CROSS PRIMARY CARE TEAM REFERRAL FORM Please ensure all sections complete & consent received from Client or Parent / Guardian Client Name Address DOB Day Gender Tel/Mobile # Month Male
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How to fill out xxx primary care team
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Gather all necessary information and documents related to the primary care team.
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Start by filling out the basic information section, which includes the patient's name, contact details, and identification number.
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Move on to the medical history section and provide accurate and detailed information about the patient's past and current medical conditions.
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Fill out the medications and allergies section, specifying any medications the patient is taking or allergies they have.
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Provide information about the patient's previous and current primary care providers.
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If applicable, fill out the insurance information section, including policy numbers and any relevant details.
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Complete any additional sections or forms required for the primary care team, such as emergency contact information or specific health conditions.
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Review the filled-out form for accuracy and completeness before submitting it to the primary care team.
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