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Recovery Services Phone: (508) 7652207 Fax: (508) 7652796Mental Health Services Phone: (508) 7652222 Fax: (508) 7642462Centralized Intake Form Patient Name:___DOB:___ Referred By: Date: Reason for

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How to fill out centralized intake formharrington hospital

01

Contact the centralized intake department at Harrington Hospital

02

Request the centralized intake form

03

Fill out the form completely and accurately with all necessary information

04

Submit the completed form to the centralized intake department

Who needs centralized intake formharrington hospital?

01

Patients seeking services at Harrington Hospital

02

Referring healthcare providers

03

Insurance companies

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What is centralized intake formharrington hospital?

Centralized intake formharrington hospital is a form used to collect information about patients and their needs in order to streamline the intake process at Harrington Hospital.

Who is required to file centralized intake formharrington hospital?

All patients seeking services at Harrington Hospital are required to fill out the centralized intake form.

How to fill out centralized intake formharrington hospital?

Patients can fill out the centralized intake form by providing their personal information, medical history, and reason for seeking services at Harrington Hospital.

What is the purpose of centralized intake formharrington hospital?

The purpose of the centralized intake form is to gather necessary information about patients in order to provide them with the best possible care and services at Harrington Hospital.

What information must be reported on centralized intake formharrington hospital?

Patients must report their personal information, medical history, insurance information, and reason for seeking services at Harrington Hospital on the centralized intake form.

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