Stanford International Patient Information Form 2017 free printable template

INTERNATIONAL MEDICAL SERVICES 300 Pasteur Drive, H 1111 Palo Alto, CA 94305 Tel: (650) 7238561 FAX: (650) 7235704INTERNATIONAL PATIENT INFORMATION FORM Contact Information Patient Name: (Last)(First)(Middle)

How to fill out Stanford International Patient Information Form

How to fill out Stanford International Patient Information Form

1. Obtain the Stanford International Patient Information Form from the official website or hospital front desk.
2. Carefully read the instructions provided at the top of the form.
3. Fill in your personal details such as your full name, date of birth, and contact information in the designated fields.
4. Provide your insurance information, including the name of your insurance provider and policy number.
5. Complete the medical history section, mentioning any previous surgeries, chronic conditions, and current medications.
6. List the reasons for your visit and any specific medical concerns you may have.
7. Provide emergency contact information, including name, relationship, and phone number.
8. Review all the information you have entered for accuracy and completeness.
9. Sign and date the form to verify that the information provided is correct.
10. Submit the form according to the guidelines provided, either online or in person at the hospital.

Who needs Stanford International Patient Information Form?

1. International patients seeking medical treatment or consultations at Stanford.
2. Patients who are referred by international physicians to receive specialized care at Stanford.
3. Individuals requiring medical evaluations while traveling or relocating to the region.
4. Patients needing insurance processing for foreign insurance companies.

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What is Stanford International Patient Information Form?

The Stanford International Patient Information Form is a document designed to collect essential information from international patients seeking medical treatment at Stanford Health Care.

Who is required to file Stanford International Patient Information Form?

International patients who wish to receive medical services at Stanford Health Care are required to file the Stanford International Patient Information Form.

How to fill out Stanford International Patient Information Form?

To fill out the Stanford International Patient Information Form, patients should provide personal details such as their name, contact information, medical history, and any relevant insurance information as instructed in the form.

What is the purpose of Stanford International Patient Information Form?

The purpose of the Stanford International Patient Information Form is to ensure that Stanford Health Care has accurate and comprehensive information about international patients for effective treatment and care.

What information must be reported on Stanford International Patient Information Form?

The information that must be reported on the Stanford International Patient Information Form includes personal identification details, contact information, medical history, current medications, and insurance information, among others.