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TIME 3:03 PM DATE 11/29/2010 PATIENT REGISTRATION ID: Chart ID: First Name: Last Name: Patient Is: Middle Initial: Preferred Name: policyholder Responsible Party (if someone other than the patient)
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How to fill out patient registration - pacific:
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Start by gathering all necessary personal information such as full name, date of birth, address, and contact details.
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Next, provide any relevant medical history, including previous illnesses, current medications, and known allergies.
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Fill in any insurance information, including the policy number, primary care physician, and any other relevant details.
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Include emergency contact information, such as the name and phone number of a trusted family member or friend.
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Sign and date the patient registration form to validate the information provided.
Who needs patient registration - pacific:
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Any individual seeking medical services at Pacific Medical Center or any affiliated medical facilities.
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New patients who are registering for the first time at Pacific Medical Center or any affiliated medical facilities.
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Existing patients who have not completed the patient registration process previously or need to update their information.
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