Get the free Patient Contact Information Addendum

ACCT# For office use only. PATIENT CONTACT INFORMATION ADDENDUM Patient Information Name:DOB:Address:City/Zip:Contact Information Check preferred method of contact Cell: ()Add cell phone cumbersome:

How to fill out patient contact information addendum

How to fill out patient contact information addendum

1. Obtain the patient contact information addendum form from the healthcare provider or download it from their website.
2. Fill in the patient's name, date of birth, and other identifying information at the top of the form.
3. Provide the patient's current address, phone number, and email address in the designated fields.
4. If the patient has an emergency contact person, include their name, relationship to the patient, and contact information.
5. Sign and date the form to certify that the information provided is accurate.
6. Return the completed addendum to the healthcare provider as instructed.

Who needs patient contact information addendum?

1. Patients who have changed their contact information since their last visit.
2. New patients who are registering with a healthcare provider for the first time.
3. Healthcare providers who need updated contact information for their patients.

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What is patient contact information addendum?

Patient contact information addendum is a form used to collect and update contact information for patients.

Who is required to file patient contact information addendum?

Healthcare providers and facilities are required to file patient contact information addendum.

How to fill out patient contact information addendum?

Patient contact information addendum can be filled out either electronically or by hand, following the instructions provided on the form.

What is the purpose of patient contact information addendum?

The purpose of patient contact information addendum is to ensure that healthcare providers have up-to-date contact information for their patients in case of emergencies or important communications.

What information must be reported on patient contact information addendum?

Patient contact information addendum typically requires patients to provide their name, phone number, address, emergency contact information, and any changes to their medical history.