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PATIENT HISTORY Patient Name:Height:Weight:Today's Date:Age Date of Birth Who Referred You: Name of Primary Care/Family Physician: Emergency Contact:Phone #:CHIEF COMPLAINT Why are you seeing the
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To fill out the Englewood Orthopedic Associates Dept form, follow these steps:
02
Start by carefully reading all the instructions on the form.
03
Provide your personal information such as name, address, and contact details in the designated fields.
04
Fill out the medical history section by providing accurate and detailed information about any previous orthopedic conditions, surgeries, or treatments you have undergone.
05
Answer all the questions pertaining to your current orthopedic issue or reason for seeking orthopedic care.
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If you have any allergies or are taking any medications, make sure to include them in the appropriate section of the form.
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Provide your insurance information if applicable.
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Review the completed form to ensure all the information is accurate and complete.
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Sign and date the form at the designated area to certify that all the information provided is true and accurate.
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Submit the filled-out form to Englewood Orthopedic Associates according to their specified instructions.

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Englewood Orthopedic Associates Department is a specialized medical facility focusing on orthopedic care, diagnosis, and treatment of musculoskeletal disorders.
Patients receiving services from Englewood Orthopedic Associates may need to file claims or paperwork related to their treatments for insurance and billing purposes.
To fill out forms related to Englewood Orthopedic Associates, patients should provide personal information, insurance details, medical history, and any specific symptoms or conditions being treated.
The purpose of Englewood Orthopedic Associates Department is to provide comprehensive orthopedic care, including diagnosis, treatment, and rehabilitation for patients with injuries or conditions affecting their bones and joints.
Information to be reported includes patient personal details, insurance information, medical history, current health issues, and treatment plans.
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