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Intake Department
Phone 6196671940
Fax 6197408584
HospiceIntake@sharp.comEmailREFERRAL FORM
TRANSITIONSHOSPICEPatient Information
Name (please print)MAN:Patient SexMaleFemaleDOB:Telephone Home:Mobile:Address
City/Zip
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What is site contact information update?
The site contact information update is a procedure for reporting and maintaining accurate contact details for a site, ensuring that regulatory authorities have up-to-date information about the individuals responsible for the site.
Who is required to file site contact information update?
Individuals or organizations responsible for managing a site, typically those involved in compliance or regulatory reporting, are required to file the site contact information update.
How to fill out site contact information update?
To fill out the site contact information update, one should collect the required contact details and complete the designated form, ensuring that all fields are properly filled with accurate and current information.
What is the purpose of site contact information update?
The purpose of the site contact information update is to ensure that relevant regulatory bodies have immediate access to correct contact details for effective communication regarding compliance, inspections, and other regulatory matters.
What information must be reported on site contact information update?
The information that must be reported includes the name of the contact person, title, phone number, email address, and the physical address of the site.
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