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Application for Membership person diagnosed is over 18, please complete Sections A and CIF person diagnosed is under 18, please complete all Sections A, B and C If there is more than one person diagnosed
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How to fill out if person diagnosed is

01
Provide accurate and updated personal information of the diagnosed person.
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Specify the exact diagnosis given by a medical professional.
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Attach any relevant medical reports or test results to support the diagnosis.
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Follow any additional instructions or guidelines mentioned in the form or provided by the medical facility.

Who needs if person diagnosed is?

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Anyone who has been officially diagnosed with a medical condition needs to fill out this form.
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This could include patients, individuals seeking medical benefits or insurance coverage, or participants in a medical research study.

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If a person is diagnosed with a medical condition, they may need to follow certain treatment plans.
The person diagnosed or their legal guardian may be required to file certain medical and legal documents.
The required forms can be filled out by providing accurate and current information about the diagnosed medical condition.
The purpose is to ensure that the diagnosed person receives proper medical care and legal protections.
The information required to be reported may include the diagnosis, treatment plan, medication, and any restrictions related to the diagnosed medical condition.
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