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Hour Chiropractic Clinic First Name: 3809 North Monroe Spokane, WA 99205 HoukChiropractic.com 9720 North Nevada Spokane, WA 99218 Confidential Patient Information Date Last Name: Initial: Major Complaint
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How to fill out our patient form
How to fill out our patient form:
01
Start by carefully reading all the instructions provided on the form. Make sure you understand what information is required and how to properly provide it.
02
Begin by filling out your personal information, such as your full name, date of birth, and contact details. Ensure that all the information is accurate and up-to-date.
03
Move on to providing your medical history. This may include any existing medical conditions, allergies, or medications you are currently taking. Be thorough and provide as much information as possible to help the healthcare provider understand your medical background.
04
Next, fill in your insurance information, if applicable. Include your insurance provider's name, policy number, and any other relevant details.
05
If the form includes a section for emergency contacts, fill it out by providing the contact information of a trusted person who can be reached during an emergency.
06
Lastly, take a few moments to review the entire form once you have completed it. Make sure all the information provided is accurate and legible.
Who needs our patient form:
01
New patients: Our patient form is required for all new patients who are seeking medical care at our facility. It helps us gather relevant information about your medical history and personal details to ensure we provide you with the best possible care.
02
Existing patients: If any of your information has changed since your last visit or if it has been a significant amount of time since your last appointment, we may ask you to fill out the patient form again. This helps us keep your records updated and ensures we have the most accurate information for your ongoing care.
03
Emergency situations: In case of an emergency, having a completed patient form on file can provide vital information to healthcare providers who may not have prior knowledge of your medical history. This allows them to make informed decisions regarding your treatment and care.
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What is our patient form?
Our patient form is a document that collects important information about the patient's medical history, current health status, and contact information.
Who is required to file our patient form?
All patients who seek medical treatment or services at our facility are required to fill out our patient form.
How to fill out our patient form?
Patients can fill out our patient form either in person at our facility or online through our patient portal.
What is the purpose of our patient form?
The purpose of our patient form is to gather necessary information to ensure proper diagnosis, treatment, and communication with the patient.
What information must be reported on our patient form?
Our patient form requires information such as personal details, medical history, current medications, allergies, and emergency contacts.
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