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364 East Main Street Ansonia, CT 064014 Corporate Drive Suite 384 Shelton, CT 06484P: 2037344806Authorization to Treat Minor Patient in Absence of Parent/Guardian I, ___, the parent and legal guardian
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What is Yale Podiatry Group 364?
Yale Podiatry Group 364 is a specific form or document associated with the Yale Podiatry Group for reporting certain information related to podiatry services.
Who is required to file Yale Podiatry Group 364?
Healthcare providers or organizations that provide podiatric services and are affiliated with Yale Podiatry Group may be required to file Yale Podiatry Group 364.
How to fill out Yale Podiatry Group 364?
To fill out Yale Podiatry Group 364, you must provide relevant information as instructed on the form, typically including patient details, service dates, and specific procedures performed.
What is the purpose of Yale Podiatry Group 364?
The purpose of Yale Podiatry Group 364 is to report podiatry services for billing, compliance, or statistical analysis.
What information must be reported on Yale Podiatry Group 364?
The information that must be reported includes patient identifiers, service details, dates of service, diagnosis codes, and provider information.
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