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This document serves as an intake form for new patients at Suffolk Physical Therapy & Chiropractic, detailing personal information, accident details, and symptoms related to injuries. It also includes insurance details and a notice of privacy practices under HIPAA.

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What is new patient no-fault intake?

New patient no-fault intake is a process used to gather necessary information from patients who are involved in no-fault motor vehicle accidents. This intake ensures that the patient's medical treatment is covered under no-fault insurance.

Who is required to file new patient no-fault intake?

Healthcare providers and medical facilities treating patients injured in automobile accidents are required to file a new patient no-fault intake form.

How to fill out new patient no-fault intake?

To fill out the new patient no-fault intake, you must provide the patient's personal information, details of the accident, insurance information, and any relevant medical history.

What is the purpose of new patient no-fault intake?

The purpose of new patient no-fault intake is to facilitate the processing of insurance claims and ensure that patients receive the appropriate medical care covered under no-fault insurance policies.

What information must be reported on new patient no-fault intake?

The information that must be reported includes the patient's name, contact information, insurance details, accident date and location, and a description of the injuries sustained.

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