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Dr. Fallon Patel and Associates Optometrists www.DrPatelOptometrist.com info@drpateloptometrist.com First Name: Last Name: Parent/Guardian (Under 18):___Address: City:Postal Code:D.O.B. Month:Day:SHIP
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Step 1: Obtain a copy of patient-form 1 from the healthcare provider.
02
Step 2: Fill in your personal information such as name, address, contact number, and date of birth.
03
Step 3: Provide details about your medical history, including any existing conditions or allergies.
04
Step 4: List any medications you are currently taking.
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Step 5: Sign and date the form to certify that the information provided is accurate.
06
Step 6: Return the completed form to the healthcare provider.
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What is patient-form 1?
Patient-form 1 is a document used to collect important information about a patient's medical history.
Who is required to file patient-form 1?
Healthcare providers and medical facilities are typically required to file patient-form 1.
How to fill out patient-form 1?
Patient-form 1 can be filled out by providing accurate and detailed information about the patient's medical history, current health status, medications, and any known allergies or medical conditions.
What is the purpose of patient-form 1?
The purpose of patient-form 1 is to ensure that healthcare providers have access to the necessary information to provide proper medical care to the patient.
What information must be reported on patient-form 1?
Patient-form 1 typically requires information such as the patient's name, date of birth, contact information, medical history, current health status, medications, allergies, and any known medical conditions.
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