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CITIZENS MEDICAL CENTER 100 East College Drive Colby, KS 67701 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PRINT FULL NAME OTHER NAMES USED BIRTHDATE SOCIAL SECURITY NUMBER TELEPHONE NUMBER I,
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How to fill out citizens medical center
01
Start by gathering all necessary personal information, such as name, date of birth, and contact details.
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Fill in the required medical history, including any pre-existing conditions, allergies, and current medications.
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Provide information about your primary healthcare provider or insurance details, if applicable.
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Answer all the health-related questions accurately and truthfully.
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Make sure to sign and date the completed form.
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Review the filled-out form for any errors or missing information before submitting it.
Who needs citizens medical center?
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Citizens Medical Center is designed to provide healthcare services to all individuals, regardless of age, ethnicity, or gender.
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It is particularly beneficial for those who require regular medical check-ups, preventive care, or treatment for chronic conditions.
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People who do not have access to a primary healthcare provider or those in need of urgent medical attention can also benefit from Citizens Medical Center.
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