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Synergy Medical 16705 Square Drive Marysville, Ohio 43040 Pregnancy Health History Form Patient Name___ DOB:___ Male Female Check appropriate box: Minor Single Married Divorced Widowed Separated SS#/
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Gather all necessary personal information of the new patient including name, date of birth, address, contact number, and insurance details.
02
Create a new patient profile in the system using the provided information.
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Verify the information provided by the patient for accuracy.
04
Fill out any medical history or health assessment forms required by the clinic or healthcare facility.
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Schedule an appointment for the new patient if necessary.

Who needs p i new patient?

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Healthcare providers such as doctors, nurses, and medical staff who are responsible for managing patient records and providing medical care.
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Administrative staff at medical facilities who are in charge of onboarding new patients and maintaining accurate patient records.

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