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KING FAMILY MEDICAL, LLC 5750 Bunker Hill Road Garland, Texas 75048 Tel: 972 6755300 Fax: 972 675 5301AUTHORIZATION FOR RELEASE OF PATIENTS PROTECTED HEALTH INFORMATION (PHI)PATIENT NAME:DOB:ADDRESS:PHONE:CITY/STATE/ZIP:This
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How to fill out king family medical pllc
01
To fill out King Family Medical PLLC, follow these steps:
02
Download the King Family Medical PLLC form from the official website or obtain a physical copy from the clinic.
03
Read the instructions carefully to understand the information required and the format to be followed.
04
Start by entering your personal information, including your full name, address, contact details, and date of birth.
05
Provide your medical history, including any pre-existing conditions, current medications, allergies, and surgeries.
06
Fill in your insurance details, including the name of the insurance provider, policy number, and group number.
07
If applicable, provide information about your primary care physician.
08
Complete the emergency contact section, including the names, relationships, and contact numbers of your emergency contacts.
09
Sign and date the form to acknowledge that the information provided is accurate and complete.
10
Review the filled-out form to ensure all fields are completed and there are no errors.
11
Submit the form to King Family Medical PLLC by mailing it to the address mentioned on the form or by hand-delivering it to the clinic.
Who needs king family medical pllc?
01
Anyone seeking medical services from King Family Medical PLLC needs to fill out the form. This form is required for all patients, including new patients and existing patients who have not completed the form previously. By filling out the King Family Medical PLLC form, patients provide the clinic with important personal and medical information necessary for their healthcare management and treatment.
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