Get the free New Patient form - Hospital for Special Surgery - hss

David A. Wang, MD Primary Care Sports Medicine Physician PRINT NAME: ADDRESS: DOB: AGE: SEX: SS# HOME: MOBILE PHONE: WORK: FAX: INSURANCE INFORMATION Did you injure yourself at work or is this injury

How to fill out new patient form

How to fill out a new patient form?

1. Start by carefully reading the instructions on the form. This will give you a clear understanding of what information needs to be provided.
2. Begin by filling out your personal information, including your full name, date of birth, gender, and contact details such as address, phone number, and email.
3. Next, provide your medical history. This may include any past illnesses or injuries, surgeries, allergies, medications you are currently taking, and any chronic conditions you may have.
4. In the section for insurance information, enter details about your health insurance provider, policy number, and any other relevant information.
5. If you have a primary care physician, make sure to provide their name, contact information, and the date of your last visit.
6. You may be asked to provide emergency contact information. Include the name, relationship, and contact details of someone who should be notified in case of an emergency.
7. Some forms also require you to sign a consent for treatment, acknowledging that you understand and agree to the terms and conditions of the healthcare provider.

Who needs a new patient form?

1. New patients: As the name suggests, new patients who are seeking medical care from a healthcare provider for the first time are typically required to fill out a new patient form. This allows the provider to gather essential information about the patient's health history and ensures they have all the necessary details to provide appropriate care.
2. Returning patients with updated information: Even if you have been a patient of a healthcare provider before, if there have been any changes to your personal or medical information, you may be asked to fill out a new patient form. This is important to ensure that records are accurate and up to date, and that your healthcare provider has the most current information about your health.
3. Patients visiting a new healthcare provider: If you have recently switched healthcare providers or are seeing a specialist for the first time, you may be asked to fill out a new patient form. This enables the new provider to have a comprehensive understanding of your medical history and any specific health concerns you may have.

In conclusion, filling out a new patient form requires careful attention to detail and providing accurate and complete information about your personal and medical history. This form is typically required for new patients, returning patients with updated information, and patients visiting a new healthcare provider. By following the provided instructions and answering each section accurately, you can ensure that your healthcare provider has the necessary information to provide you with the best possible care.

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