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PATIENT AND FAMILY INFORMATION AND CHECKLIST FOR Pediatric INPATIENT SURGERY Please follow the instructions below for COVID-19 screening and preparing for surgery. Patients/families who have not taken

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How to fill out patient and family information

01

Start by gathering all the necessary information such as full name, date of birth, address, and contact details of the patient.

02

Next, collect information about the patient's family members including their names, relationship to the patient, and contact information.

03

Fill out the patient and family information sections carefully and accurately on the required forms or electronic systems.

04

Double-check all the information provided to ensure it is complete and correct before submitting it to the healthcare provider.

Who needs patient and family information?

01

Healthcare providers such as doctors, nurses, and medical staff who are responsible for providing care to the patient.

02

Insurance companies may also require patient and family information for billing and coverage purposes.

03

Patient advocacy organizations and support groups may use this information to provide assistance and resources to the patient and their family.

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What is patient and family information?

Patient and family information includes details about the patient's medical history, contact information, insurance details, and emergency contacts.

Who is required to file patient and family information?

Healthcare providers, hospitals, and clinics are required to file patient and family information for each individual receiving medical care.

How to fill out patient and family information?

Patient and family information can be filled out either electronically through a secure online portal or manually on paper forms provided by the healthcare facility.

What is the purpose of patient and family information?

The purpose of patient and family information is to ensure that healthcare providers have accurate and up-to-date information about the patient's medical history, preferences, and emergency contacts to provide appropriate and timely care.

What information must be reported on patient and family information?

Patient and family information must include personal details such as name, date of birth, address, medical history, allergies, medications, insurance information, and emergency contacts.

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