CA Stanford Health Care Form 15-79-1 2015 free printable template
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STANFORD HEALTH CARE (SHE)Please send SHE requests to: Stanford Health Care (SHE) Health Information MGMT C14, MC 5200 420 Broadway, Redwood City, CA 94063 Phone: (650) 7235721 | Fax: (650) 7259821AUTHORIZATION
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How to fill out CA Stanford Health Care Form 15-79-1
How to fill out CA Stanford Health Care Form 15-79-1
01
Obtain the CA Stanford Health Care Form 15-79-1 from the official website or the hospital's administrative office.
02
Read the instructions on the form carefully to understand the information required.
03
Fill out the patient information section, including the patient's full name, date of birth, and contact information.
04
Complete the insurance information section with the relevant details of the patient's health insurance provider.
05
Provide a detailed medical history and any current health conditions in the designated section.
06
Sign and date the form where indicated to confirm the information provided is accurate.
07
Submit the completed form to the designated department or office at Stanford Health Care either in person or via email.
Who needs CA Stanford Health Care Form 15-79-1?
01
Patients seeking treatment at Stanford Health Care who need to provide medical and insurance information.
02
Individuals authorized to manage a patient's health care logistics, such as family members or guardians.
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People Also Ask about
Is Stanford Health Care the same as Stanford hospital?
Although the leadership of Stanford Health Care and Stanford University work in close partnership, the hospital and university are separate legal entities.
Is Stanford Medicine the same as Stanford University?
Stanford School of Medicine is a part of Stanford University, one of the world's leading teaching and research universities.
What is the name of Stanford hospital?
Stanford University Medical Center is a medical complex which includes Stanford Health Care and Stanford Children's Health.
How do I get my medical records from Stanford hospital?
As a patient, you or your legal representative may obtain a copy of your medical records or have copies of your medical records sent to another person or facility. You can fill out the request for your records online by logging in to MyHealth on the web and completing the form under My Medical Records>Request Records.
Where do I get my birth certificate if I was born in Stanford hospital?
Birth certificates can be requested directly by calling Alameda County Offices at 510-272-6362.
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What is CA Stanford Health Care Form 15-79-1?
CA Stanford Health Care Form 15-79-1 is a specific form used by Stanford Health Care for reporting financial or healthcare-related information required by regulatory authorities in California.
Who is required to file CA Stanford Health Care Form 15-79-1?
Providers, institutions, or entities involved in offering healthcare services in California that are affiliated with Stanford Health Care are typically required to file CA Stanford Health Care Form 15-79-1.
How to fill out CA Stanford Health Care Form 15-79-1?
To fill out CA Stanford Health Care Form 15-79-1, follow the instructions provided on the form itself, ensuring that all required fields are completed with accurate information regarding the healthcare services provided, financial data, and any relevant patient information as mandated.
What is the purpose of CA Stanford Health Care Form 15-79-1?
The purpose of CA Stanford Health Care Form 15-79-1 is to gather essential data from healthcare providers for compliance with state regulations, ensuring transparency and accountability in healthcare delivery.
What information must be reported on CA Stanford Health Care Form 15-79-1?
The information that must be reported on CA Stanford Health Care Form 15-79-1 includes details about patient demographics, types of services provided, financial information, and compliance with healthcare regulations.
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