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CONFIDENTIAL 1720 Lafayette Rd. STE A Crawfordsville, In 47933 pH. 7653234689 Fax 7653628222Authorization to Release Healthcare Information Patient Name: Date of Birth: Previous Name: SSN: I request
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What is franciscan st elizabeth health?
Franciscan St. Elizabeth Health is a healthcare organization that provides a range of medical services, including emergency care, surgical procedures, and outpatient services, primarily serving communities in Indiana.
Who is required to file franciscan st elizabeth health?
Those who are patients receiving care at Franciscan St. Elizabeth Health or those who have utilized its services may be required to file information as part of billing and insurance procedures.
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To fill out forms related to Franciscan St. Elizabeth Health, one typically needs to provide personal information, medical history, insurance details, and any required financial information as instructed on the specific forms.
What is the purpose of franciscan st elizabeth health?
The purpose of Franciscan St. Elizabeth Health is to deliver comprehensive healthcare services to improve the health and well-being of the communities they serve, following the mission of the Franciscan order to provide compassionate care.
What information must be reported on franciscan st elizabeth health?
Information that must be reported typically includes patient identification details, service received, treatment information, financial billing details, and insurance claims.
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