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Dennis L. Fernandez, M.D., P.C. Patient Information Patients Name___ Last NameFirst NameMiddle Headdress___ City___ () () State___ Zip___ Home Phone___ Cell Phone___ Sex___ Date of Birth ___ SSN___
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It is a set of intake documents for new patients dated October 16, 2018.
New patients or their guardians are required to fill out and file the intake documents.
The documents can be filled out electronically or manually by providing all the requested information accurately.
The purpose is to gather necessary information about new patients for healthcare providers to provide appropriate care and treatment.
Information such as personal details, medical history, insurance coverage, and emergency contacts must be reported on the intake documents.
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