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Sacramento Occupational Medical Group Fidel Realyvasquez, M.D. Medical Director New Employer Injury Intake Form Employer/ Business Name: Address: City: State: Zip: Main Phone: Main Fax: Primary Contact:
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How to fill out sacramento physicians medical
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Step 1: Obtain the necessary forms, either from the Sacramento Physicians Medical office or online.
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Step 2: Begin by providing your personal information, including your full name, contact details, and date of birth.
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Step 3: Fill out the medical history section, providing details about any pre-existing conditions, medications, or allergies.
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Step 4: Provide information about your primary care physician, if applicable.
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Step 5: Include any relevant insurance information, such as policy numbers and provider contact details.
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Step 6: Complete the consent section, acknowledging your understanding of the medical office's privacy policies.
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Step 7: Review the completed form for accuracy and completeness.
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Step 8: Sign and date the form.
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Step 9: Submit the filled-out form to the Sacramento Physicians Medical office, either in person or by mail.
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Sacramento Physicians Medical refers to the medical services and practices provided by physicians in Sacramento, focusing on patient care, diagnosis, and treatment across various specialties.
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