Get the free DOR17-07 The Everett Clinic. DOR17-07 The Everett Clinic - doh wa

STATE OF WASHINGTON DEPARTMENT OF HEALTH Certificate of Need Program 111 Israel Road Southeast MS 47852 Olympia, Washington 98504 February 24, 2017, Tyler Jung, MD The Everett Clinic 3901 Host Avenue

How to fill out dor17-07 form everett clinic

How to fill out dor17-07 form everett clinic

1. Step 1: Begin by obtaining a copy of the dor17-07 form from the Everett Clinic.
2. Step 2: Review the form and familiarize yourself with the information that needs to be provided.
3. Step 3: Start filling out the form by entering your personal details, such as your name, address, and contact information.
4. Step 4: Provide the relevant medical information, including any existing medical conditions or allergies.
5. Step 5: If there are any specific questions or sections on the form that require additional documentation, make sure to attach the necessary records.
6. Step 6: Double-check all the information you have entered to ensure accuracy and completeness.
7. Step 7: Once you have filled out the form, sign and date it to authenticate your submission.
8. Step 8: Submit the completed dor17-07 form to the designated department or personnel at the Everett Clinic.
9. Step 9: Keep a copy of the filled-out form for your records.
10. Step 10: If needed, follow up with the clinic to ensure that your form has been received and processed.

Who needs dor17-07 form everett clinic?

1. Patients who have received medical services from the Everett Clinic may need to fill out the dor17-07 form.
2. This form is typically required for medical records, billing, or insurance purposes.
3. It may be requested by the clinic's administration, healthcare providers, or insurance companies.
4. Specific circumstances, such as filing a claim or seeking reimbursement, might also necessitate the completion of this form.
5. If you are unsure whether you need to fill out the dor17-07 form, it is advisable to contact the Everett Clinic directly for clarification.

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What is dor17-07 form everett clinic?

The dor17-07 form from Everett Clinic is a document used for reporting certain information related to healthcare services provided.

Who is required to file dor17-07 form everett clinic?

Healthcare providers and facilities such as Everett Clinic are required to file the dor17-07 form.

How to fill out dor17-07 form everett clinic?

The dor17-07 form from Everett Clinic can be filled out electronically or manually, following the instructions provided on the form.

What is the purpose of dor17-07 form everett clinic?

The purpose of the dor17-07 form from Everett Clinic is to report healthcare services provided to patients for record-keeping and billing purposes.

What information must be reported on dor17-07 form everett clinic?

The dor17-07 form from Everett Clinic requires information such as patient demographics, services provided, dates of service, and billing codes.