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Station House Pediatrics
2228 Black Rock Turnpike
Fairfield, CT 06825
Phone (203) 3759350
Fax (203) 37s8013HIPAA Authorization FOR RELEASE OF PATIENT RECORDS
PatienUClient name:[,
hereby authorize
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01
Start by collecting all necessary information, such as personal and insurance details of the patient.
02
Open the patient's file or form provided by Station House Pediatrics.
03
Fill in the patient's personal information accurately, including full name, date of birth, gender, and contact information.
04
Provide the patient's insurance information, including the insurance company, policy number, and any relevant details.
05
Specify the reason for the visit or appointment in the corresponding field.
06
If applicable, include any additional medical history or relevant details about the patient.
07
Review the filled out form for accuracy and completeness.
08
Sign and date the form as required.
09
Submit the filled out form to the designated personnel at Station House Pediatrics.
Who needs station house pediatrics?
01
Station House Pediatrics is needed by individuals who require pediatric medical care for their children.
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It is especially beneficial for parents or guardians seeking comprehensive healthcare services for infants, toddlers, children, and adolescents.
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Those who value a personalized and child-friendly approach to medical treatment can benefit from Station House Pediatrics.
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Parents who are looking for experienced pediatricians and a caring medical team can rely on Station House Pediatrics for their child's health needs.
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What is station house pediatrics?
Station House Pediatrics is a pediatric clinic located in the city center.
Who is required to file station house pediatrics?
Parents or legal guardians of pediatric patients.
How to fill out station house pediatrics?
You can fill out station house pediatrics by providing accurate information about the pediatric patient's medical history and current health status.
What is the purpose of station house pediatrics?
The purpose of station house pediatrics is to provide medical care and treatment for pediatric patients.
What information must be reported on station house pediatrics?
Information such as the pediatric patient's name, age, medical history, current medications, allergies, and any existing medical conditions.
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