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PATIENT REGISTRATION FORM Center Name: Phone: Address: Fax: Patient Information Male Patient Name: Female Address: Street City State Zip Mailing Address: (if different from above) Date of Birth: Social
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How to fill out referring physician phone number:

01
Locate the section on the form asking for the referring physician's contact information.
02
Enter the referring physician's phone number in the designated field.
03
Ensure that you accurately enter all digits of the phone number, including the area code.

Who needs referring physician phone number:

01
Healthcare providers: Doctors, nurses, and other healthcare professionals may need the referring physician's phone number to communicate and coordinate patient care.
02
Insurance companies: Insurance providers may require the referring physician's phone number to verify medical referrals or gather additional information.
03
Patients: Patients may need the referring physician's phone number to schedule appointments or ask questions related to their referrals or medical condition.
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The referring physician phone is the contact number for the doctor who referred a patient for medical services.
Healthcare providers and facilities are required to include the referring physician phone on medical records and claims for services.
The referring physician phone should be completed with the full phone number including area code, and any extensions if necessary.
The purpose of including the referring physician phone is to facilitate communication between healthcare providers and ensure accurate documentation of patient care.
The referring physician phone should include the phone number of the doctor who referred the patient for medical services.
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