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Contact for Health Info: Clinic/Hospital: Phone: Fax: ? (Physicians) I am referring this child for Chilling EI evaluation. Health Information & EI prescription below. NOTE: If you want to send us
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To fill out the contact of health info, follow these steps:

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Start by providing your personal information such as your full name, date of birth, and current address. This will help the health professionals identify you accurately.
02
Next, include your contact details such as your phone number and email address. This will allow the healthcare providers to reach out to you if necessary.
03
It is important to mention your emergency contact information. Provide the name and phone number of someone who can be contacted in case of an emergency or when you are unable to communicate.
04
Specify your primary healthcare provider's contact details. This includes their name, phone number, and address. This information helps in establishing a line of communication between your primary care doctor and other healthcare providers.
05
In certain cases, you might need to include information about your insurance coverage. If applicable, include the name of your insurance company, policy number, and any relevant contact details.
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Lastly, sign and date the contact of health info form to validate the information provided. Your signature confirms that the details provided are accurate and up to date.

Who needs contact of health info?

01
Patients: It is crucial for individuals to fill out the contact of health info form as it ensures that healthcare providers have accurate and up-to-date information about them. This information is essential for providing appropriate medical care.
02
Healthcare Providers: The contact of health info form is necessary for healthcare providers as it allows them to reach patients in case of emergencies, follow-up appointments, and to coordinate care with other healthcare professionals involved in the patient's treatment.
03
Caregivers and Family Members: Having access to the contact of health info form ensures that caregivers and family members can be contacted in emergencies or when the patient is unable to communicate. This enables them to assist in providing necessary information and support to the healthcare team.
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Contact of health info is a form or documentation that includes an individual's medical information and emergency contact details.
All individuals who receive medical treatment or services are required to file contact of health info with their healthcare provider.
Contact of health info can be filled out by providing accurate and updated medical information, emergency contact details, and any relevant allergies or medical conditions.
The purpose of contact of health info is to ensure that healthcare providers have access to important medical information and emergency contact details in case of a medical emergency or for treatment purposes.
Information such as medical history, current medications, allergies, emergency contact details, and any medical conditions must be reported on contact of health info.
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Relevant keywords

EI childs ChildLink IFSP MDE hosp PHMC Rx DBH 18th wks ICD addl devl Observ NICU 3rd PCP Immunizations Individualized contra multi IdS DOB Todays eligibility Referrals Therapies Diagnoses Developmental

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