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The contents of this form can be combined with such existing consent forms. 2013 Smith Moore Leatherwood LLP All rights reserved. PATIENT BILLING AND FINANCIAL POLICY As a courtesy Blue Ridge Pediatrics LLP will file a claim for all services to your insurance. Main Office Brier Creek Office 3124 Blue Ridge Road Suite 102 10208 Cerny Street Suite 104 Raleigh NC 27612 Office Number 919 782 0021 Office Number 919 226 0662 Patient s Last Name First Name Middle Initial DOB //...
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01
To fill out the 'dobgendermalefemalepatientphoneif16yrs', follow these steps:
02
Start by entering the Date of Birth (dob) of the patient. The format should be in MM/DD/YYYY.
03
Select the gender of the patient. Choose either 'Male' or 'Female' from the options provided.
04
Enter the patient's phone number if they are 16 years or older. The format should be a valid phone number.
05
Once all the required information is filled out, proceed to submit the form or save the data.
Who needs dobgendermalefemalepatientphoneif16yrs?
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The form 'dobgendermalefemalepatientphoneif16yrs' is needed by healthcare providers and medical facilities.
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It is primarily used for patient registration and record-keeping purposes.
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It ensures that accurate and up-to-date information about the patient's date of birth, gender, and contact details is recorded.
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This information is essential for providing appropriate healthcare services and communicating with the patient when necessary.
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