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New Patient Demographics Last Name: ___ First Name: ___ Middle: ___ Nickname/Preferred Name: ___ Date of Birth: ___ Social Security Number: ___ Address: ___ City: ___ State: ___ Zip Code: ___ Home
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How to fill out patient name

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Start by writing the patient's first name in the designated field
02
Next, write the patient's last name in the appropriate space
03
Double check that the spelling of the name is correct
04
If the patient has a middle name, include it as well

Who needs patient name?

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Healthcare providers
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Hospital staff
03
Insurance companies
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Patient name is the name of the individual receiving medical treatment.
Healthcare providers are required to accurately report patient names in medical records.
Patient names should be filled out accurately and completely, including first name, last name, and any suffixes or prefixes.
The purpose of patient name is to uniquely identify the individual receiving medical treatment.
Patient name should include first name, last name, and any additional identifying information as needed.
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