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PATIENT TEL #:___ WILL YOU NEED COPY OF RECORD(S) WHEN RECEIVED? ___YES ___NO AUTHORIZATION FOR DISCLOSURE OF MEDICAL OR DENTAL INFORMATION PRIVACY ACT STATEMENT In accordance with the Privacy Act

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01

Obtain the patient registration form from the hospital front desk.

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Fill out all required fields on the form, including personal information such as name, address, date of birth, and contact information.

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Who needs martin army community hospitalpatient?

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Patients who require medical treatment or services from Martin Army Community Hospital need to fill out the patient registration form.

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What is martin army community hospitalpatient?

Martin Army Community Hospital Patient refers to individuals receiving medical care and services at the Martin Army Community Hospital, which serves military personnel and their families.

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Patients who have received medical treatment at Martin Army Community Hospital and are required to submit any necessary health records or documentation.

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The purpose is to ensure that medical records are accurately maintained for each patient to facilitate ongoing care, billing, and compliance with healthcare regulations.

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