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ATHLETIC INJURIES OF ATLANTA
DR. COLLEEN M. PIOAppt@AIOA. Net: 7705215566 Fax: 8882550268 2785 Buford Hwy, Ste. 102B, Duluth, GA 30096PLEASE COMPLETE AND SIGN ALL FIVE (5) PAGES AS APPLICABLE
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01
Begin by opening the AIoA New Patient Form 120118doc document on your device.
02
Read the instructions and form carefully to understand the information required.
03
Fill in your personal details such as name, date of birth, address, and contact information in the designated fields.
04
Provide your medical history by answering the questions related to your current and past health conditions, medications, allergies, and surgeries.
05
If applicable, enter the details of your primary care physician and any other healthcare providers you visit regularly.
06
Complete the insurance section by filling in the necessary insurance information, including policy number and primary and secondary insurers.
07
Sign and date the form to certify that the provided information is accurate and complete.
08
Review your filled-out form to ensure all the required fields are completed and the information is legible.
09
Submit the completed AIoA New Patient Form 120118doc to the relevant healthcare provider or organization as instructed.
Who needs aioa newpatientform 120118doc?
01
The AIoA New Patient Form 120118doc is needed by individuals who are new patients at a healthcare provider or organization.
02
It is specifically required to gather and document the patient's personal and medical information necessary for providing healthcare services and maintaining medical records.
03
Anyone seeking medical care or treatment from a new healthcare provider or organization will typically need to fill out this form.
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What is aioa newpatientform 120118doc?
aioa newpatientform 120118doc is a form used for new patient registration and information gathering.
Who is required to file aioa newpatientform 120118doc?
New patients at a healthcare facility are required to fill out the aioa newpatientform 120118doc.
How to fill out aioa newpatientform 120118doc?
To fill out aioa newpatientform 120118doc, patients must provide personal information, medical history, insurance details, and contact information.
What is the purpose of aioa newpatientform 120118doc?
The purpose of aioa newpatientform 120118doc is to collect essential information about new patients for medical records and billing purposes.
What information must be reported on aioa newpatientform 120118doc?
Information such as patient's name, address, date of birth, medical history, insurance information, emergency contacts, etc. must be reported on aioa newpatientform 120118doc.
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