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Tomato Saudi, MS, PT, RAY, Cert. MDT 24076 SE Stark St., Ste. 210 Gresham, OR 97030 Phone: 5034911666 Fax: 5034911667 Patient Name: Phone Number: DOB: Diagnosis/ICD 10 Code: Special Orders or Precautions:
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Begin by providing your personal information, including your full name, address, date of birth, and contact details.
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Specify your insurance information, such as the name of your insurance company and your policy number.
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Indicate your primary care physician’s name and contact information.
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Fill out your medical history accurately, including any chronic conditions, previous surgeries, allergies, and medications you are currently taking.
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If you have any questions or concerns, don't hesitate to contact NCH healthcare for assistance.

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Anyone seeking to receive healthcare services from NCH healthcare may need to fill out the welcome form.
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Existing patients may also need to update their information periodically by filling out a new welcome form.
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The form helps NCH healthcare in understanding the patient's medical history, insurance information, and contact details, which are crucial for providing appropriate care and communication.
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Welcome to NCH Healthcare is an introduction to the services, facilities, and care options provided by NCH Healthcare system, aimed at helping patients understand their healthcare journey.
Individuals seeking services from NCH Healthcare, including patients and their caregivers, are required to file welcome to NCH Healthcare documentation.
To fill out welcome to NCH Healthcare, individuals should complete the provided forms accurately, providing necessary personal and medical information as instructed.
The purpose of welcome to NCH Healthcare is to ensure that patients receive a clear understanding of the healthcare services available to them and to facilitate a smooth admission and treatment process.
Information that must be reported on welcome to NCH Healthcare includes personal identification details, medical history, current medications, and insurance information.
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