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Please, Read the Instructions Before Filling Out This Form. Enrollment and Change Formulas TYPE OR PRINT CLEARLY using blue or black ink to avoid coverage delay or type in informationPlease mail to:

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How to fill out current medical group

01

Obtain the necessary forms from the medical group or provider

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Complete the personal information section including name, contact information, and insurance details

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Provide a detailed medical history including current medications, allergies, and any pre-existing conditions

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Fill out any consent forms or authorization for release of information

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Who needs current medical group?

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Individuals who are new patients to a medical group

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Patients who are seeking specialized medical care or treatment

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What is current medical group?

Current medical group refers to the most up-to-date list of healthcare providers and facilities that an individual is currently being treated by or receiving services from.

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The individual or their authorized representative is required to file the current medical group.

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The current medical group can be filled out by providing detailed information about the healthcare providers and facilities that the individual is currently involved with.

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The purpose of the current medical group is to ensure that all healthcare providers and facilities involved in an individual's care are properly documented and accounted for.

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Information such as the name, address, contact information, and specialty of each healthcare provider or facility must be reported on the current medical group.

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