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Family and Pediatric Medicine of Grand Rapids 4130 Breton Rd SE, Suite B Grand Rapids, MI, 49512 Phone 6162810093 / Fax 6162810580Medical Records Disclosure Log HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY

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How to fill out contact family and pediatric

01

Fill out the contact family and pediatric section by providing the contact information of the family members.

02

Include the name, relationship, phone number, and email address of each family member.

03

For the pediatric section, include the name, age, date of birth, and any medical conditions or allergies of the child.

Who needs contact family and pediatric?

01

Medical professionals who need to communicate with the patient's family members or caregivers.

02

Emergency responders who need to contact family members in case of an emergency involving the patient.

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What is contact family and pediatric?

Contact family and pediatric is a form used to report contact information for family members and pediatric patients.

Who is required to file contact family and pediatric?

Healthcare professionals and facilities are required to file contact family and pediatric.

How to fill out contact family and pediatric?

Contact family and pediatric can be filled out online or using a paper form provided by the relevant authority.

What is the purpose of contact family and pediatric?

The purpose of contact family and pediatric is to ensure that healthcare providers have updated contact information for family members and pediatric patients in case of emergencies.

What information must be reported on contact family and pediatric?

Information such as names, phone numbers, addresses, and relationships of family members and pediatric patients must be reported on contact family and pediatric.

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