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Summit Pain 1818 East 23RD Ave Hutchinson, Ks 67502Patients Name: ___ SSN#: ___ Date of Birth: ___ Age: ___ Sex: ___ Marital Status: Single Married Widowed Divorced Home Address: ___ P.O. Box: ___
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Gather all necessary information and documents required for summit surgical home application.
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Visit the summit surgical home website or contact their office to obtain the application form.
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Fill out the application form completely and accurately with your personal information and medical history.
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Submit the completed application form along with any supporting documents to summit surgical home for review.
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Who needs summit surgical home?

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Individuals who require surgical procedures and prefer to recover at home instead of in a hospital.
02
Patients who are looking for a more comfortable and personalized care experience during their post-operative period.
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Summit Surgical Home is a facility that provides outpatient surgical procedures in a comfortable and convenient setting.
Summit Surgical Home is required to be filed by healthcare facilities that offer outpatient surgical services.
Summit Surgical Home can be filled out by providing all the necessary information about the facility and the services it offers.
The purpose of Summit Surgical Home is to ensure that outpatient surgical facilities are operating in compliance with regulations and providing safe care to patients.
Information such as facility location, services offered, staff credentials, and safety protocols must be reported on Summit Surgical Home.
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