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Pediatric Intake Format. Franceville Rehab ServicesPhysical TherapyAquatic Therapy Occupational Therapy Speech Therapy IF PATIENT IS UNDER 18 YEARS OF AGE A LEGAL GUARDIAN MUST SIGN ALL PAPER Forename:
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How to fill out completed pediatric intake packet

01
Start by entering the child's personal information such as name, date of birth, and contact details.
02
Provide details about the child's medical history including any conditions, allergies, and medications currently being taken.
03
Record any family history of medical conditions or illnesses.
04
Note down any previous surgeries or hospitalizations the child has undergone.
05
Fill in information about the child's primary care physician and any specialists they may be seeing.
06
Complete the section on insurance information and provide a copy of the child's insurance card if necessary.
07
Sign and date the completed intake packet to confirm accuracy and consent.
08
Make sure all sections are filled out accurately and completely before submitting the packet.

Who needs completed pediatric intake packet?

01
Parents or legal guardians of pediatric patients.
02
Pediatricians, specialists, or healthcare providers treating the child.
03
Medical institutions or clinics requesting comprehensive health information for pediatric patients.
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Completed pediatric intake packet is a form that includes all necessary information about a child's medical history, current health status, and any other relevant details.
Parents or legal guardians of the child are required to file the completed pediatric intake packet.
The completed pediatric intake packet can be filled out by providing accurate and detailed information about the child's medical history, allergies, medications, and any other relevant details.
The purpose of the completed pediatric intake packet is to provide healthcare providers with all necessary information to ensure proper care and treatment for the child.
The completed pediatric intake packet must include the child's medical history, current health status, allergies, medications, and any other relevant details.
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