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NEW PATIENT REGISTRATION FORM
CVHS ACCT: ___
PATIENT INFORMATION
First Name:
Middle Initial:Last Name, Suffix:Preferred Name:Mailing Address:
Street Address (if different from mailing address):
Home
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How to fill out new patient registration 10082020docx
How to fill out VA Central Virginia Health Services New Patient
01
Visit the VA Central Virginia Health Services website or office.
02
Download or request the New Patient Registration form.
03
Fill out your personal information including name, address, phone number, and Social Security number.
04
Provide details about your military service, including branch of service and dates of service.
05
Disclose any current medical conditions or medications.
06
Complete the consent and authorization sections of the form.
07
Submit the completed form either online, in-person, or via mail to the health services.
Who needs VA Central Virginia Health Services New Patient?
01
Veterans seeking healthcare services through the VA.
02
New patients who have not previously received care from VA Central Virginia Health Services.
03
Individuals who are looking to establish care with a VA healthcare provider.
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What is VA Central Virginia Health Services New Patient?
VA Central Virginia Health Services New Patient refers to the process and documentation required for individuals seeking to register as new patients within the VA Central Virginia Health Services system.
Who is required to file VA Central Virginia Health Services New Patient?
Veterans, their dependents, and eligible individuals seeking healthcare services from VA Central Virginia Health Services are required to file as new patients.
How to fill out VA Central Virginia Health Services New Patient?
To fill out the VA Central Virginia Health Services New Patient form, individuals should provide personal information, contact details, military service history, and any relevant medical history as instructed on the form.
What is the purpose of VA Central Virginia Health Services New Patient?
The purpose of VA Central Virginia Health Services New Patient documentation is to ensure proper registration and the provision of necessary healthcare services tailored to new patients.
What information must be reported on VA Central Virginia Health Services New Patient?
The information that must be reported includes the patient's name, date of birth, Social Security number, contact information, military service information, current health conditions, and any existing medical records.
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