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Page 1/2 The Pediatric Center of Stone Mountain, LLC Medical Records Release INCOMING PATIENT INFORMATION: First Name:Middle Name:Last Name:Date of Birth:Street Address:City:State:Zip Code:I, (full
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Form Pediatric Center of is a regulatory document used by pediatric healthcare facilities to report specific operational and demographic information.
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Pediatric healthcare facilities, including hospitals and outpatient centers that provide specialized pediatric care, are required to file this form.
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To fill out the form, facilities should gather necessary data, follow the provided instructions on the form, and submit it to the appropriate regulatory agency by the deadline.
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The purpose of the form is to collect data on pediatric care facilities to ensure compliance with healthcare regulations and to enhance the quality of care provided to children.
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Information such as facility name, address, type of services offered, number of pediatric beds, and staff qualifications must be reported.
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