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SELLWOOD MEDICAL CLINIC 8332 SE. 13TH Portland OR 97202 Telephone 503-595-9300 Fax 503-595-9301 Charles B. D. AUTHORIZATION FOR RELEASE OF INFORMATION TO SELLWOOD MEDICAL CLINIC PC PATIENT INFORMATION DOB SS I authorize Name of Provider/Facility Address of Provider/Facility Phone/Fax of Provider/Facility to disclose my health information specific to the following date or time period Individual or entity authorized to receive my health information Sellwood Medical Clinic 8332 S.E. 13th Ave....

How to fill out sellwood medical clinic

How to fill out sellwood medical clinic

1. Start by obtaining the necessary medical forms from Sellwood Medical Clinic.
2. Fill out the personal information section, including your full name, address, phone number, and date of birth.
3. Provide your insurance information, if applicable. This may include your insurance provider's name, policy number, and group number.
4. Indicate your medical history, including any previous or current medical conditions, medications you are taking, and any allergies or sensitivities.
5. Note down the reason for your visit and any specific symptoms or concerns you have.
6. Answer any additional questions or sections as required by the clinic, such as emergency contact information or consent forms.
7. Double-check all your answers for accuracy and completeness.
8. Sign and date the form at the designated space.
9. Submit the completed form to Sellwood Medical Clinic either in person, by mail, or through their online portal, if available.

Who needs sellwood medical clinic?

1. Sellwood Medical Clinic serves individuals of all ages and backgrounds who require medical care.
2. This includes but is not limited to:
3. - Patients seeking general check-ups and preventative care
4. - Individuals with acute or chronic illnesses
5. - Expectant mothers in need of prenatal care
6. - Children in need of pediatric care
7. - Senior citizens in need of geriatric care
8. - Individuals requiring specialized medical services offered by Sellwood Medical Clinic
9. In summary, Sellwood Medical Clinic caters to anyone in need of professional medical attention.

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What is sellwood medical clinic?

Sellwood Medical Clinic is a healthcare facility that provides medical services to patients in the Sellwood area.

Who is required to file sellwood medical clinic?

Sellwood Medical Clinic is required to file by the healthcare facility's administrators or designated staff members.

How to fill out sellwood medical clinic?

Sellwood Medical Clinic can be filled out by collecting and documenting the necessary medical information of patients during their visit to the clinic.

What is the purpose of sellwood medical clinic?

The purpose of Sellwood Medical Clinic is to provide healthcare services, diagnose medical conditions, and offer treatment to patients.

What information must be reported on sellwood medical clinic?

Information such as patient demographics, medical history, diagnosis, treatment plans, and billing details must be reported on Sellwood Medical Clinic forms.