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PATIENT Z documents



Pages: 1
Patient z filesPatient Info Sheet

Microsoft Word - Patient Info Sheet.doc Patient INFORMATIONNAME SEX MFLAST FIRST MIDDLEADDRESSCITYSTATEZIPTELEPHONEHOMETELEPHONEWORKMARITALSTATUS SMDWBIRTHDATEAGE SOCIAL SECURITY DRIVER S LICENSEEMPLOYER NAME OCCUPATIONWORK ADDRESS CITY ZIPNAME OF SPOUSELAST FIRST MIDDLE INITIALWORK ADDRESSCITY STATEZIPIN AN EMERGENCY NOTIFYTELEPHONE RELATIONSHIPPRIMARY ISURANCE COMPANYINSUREDINSURED SS INSURED ...

mytexasallergy.com/forms/Patient... Info Sheet.pdf
  • Author: none
  • Size: 11 KB
  • Created: Thu Oct 14 15:24:58 2010
Pages: 14
Patient z files6302011 Revised Patient Assistance Application

Microsoft Word - 6302011 REVISED Patient Assistance Application.doc MISSION STATEMENTThe mission of Dani s Foundation a charitable organization that was formed in 1999 is to find the cause andthe cure for sarcomas affecting children and young adultsDani s Foundation is dedicated to advancing a global initiative that will be aimed atFunding research that will find the cause and the cure for sarcoma...

danisfoundation.org/wp-content/uploads/2011/06/6302011-...Application.pdf
  • Author: none
  • Size: 157 KB
  • Created: Mon Jun 27 16:37:53 2011
Pages: 1
Patient z filesPatient Information Sheet 2011

Patient Information Sheet 2011 Patient INFORMATION SHEETName Date Address Home Phone City State Cell Phone Zip Sex Soc Security Date of Birth Age Email address Patient s Employer Occupation Employer s Address City State Zip Work Phone Marital Status Spouse s Name DOBEMERGENCY contact Phone Patient Primary Care Physician Phone Party responsible for account If Work Comp or Auto provide ...

lowbackpain.com/cms/gallery/Patient-Information-Sheet-2...-Sheet-2011.pdf
  • Author: none
  • Size: 80 KB
  • Created: Sat Sep 10 01:27:01 2011
Pages: 4
Patient z filesPatient Transport Pat Tra 1 20110726 Rd V2 Final 2

Non-Emergency Patient Transport ServicesInformation for patientsPatient Transport Number 01622 224720Ambulance Patient transport servicePatient transport is only available to patients who have beenassessed as medically unable to make their own way to and orfrom their healthcare appointment If you have a medicalcondition or disability which means you are unable to travel onpublic transport or in a ...

kentoncologycentre.co.uk/images/content/Patient Transpo...2 FINAL (2).pdf
  • Author: none
  • Size: 95 KB
  • Created: Mon Oct 17 17:03:39 2011
Pages: 15
Patient z filesPatient Guide

Patient Guide To Programs ServicesINSIDE PAGE NOWelcome 1LocationHours of OperationFinancial Assistance 2Payment OptionsYour First Visit 3Scheduling AppointmentsPrograms Services Descriptions 4Notice of Privacy Practices 8Patient Bill of Rights 10Contract for Care 11Referral Payment Agreement 12CANAL STREETMANCHESTER COMMUNITY HEALTH CENTER2nd FloorENTER at First FloorENTERTake Stairs or ElevatorP...

mchc-nh.org/files/Pa...tient Guide.pdf
  • Author: none
  • Size: 1068 KB
  • Created: Mon Jun 14 11:05:47 2010
Pages: 1
Patient z filesPatient Medical History

Patient-medical-history-november-2011 Patient Medical HistoryPlease print this form fill it out and either fax it or bring it with you for your visit Thank youNameDate of Birth Today s Date Tempe Officemo date year mo date year 6301 S McClintock DrFirst Day of Contraception Suite 215Last Menses mo date year Tempe AZ 85283Allergies to Medications Phone 480 820-6657Fax 480 730-0803NoneGilbert Office...

dev.swwomenscare.com.php53-5.dfw1-2.websitetestlink.com...cal-history.pdf
  • Author: none
  • Size: 308 KB
  • Created: Thu Nov 3 14:46:44 2011
Pages: 28
Patient z filesDoctor Patient Small Talk Medical Discourse

Small talk, high stakes: Interactional disattentiveness in the context of prosocial doctor-Patient interaction Language in Society 37 661 688 Printed in the United States of Americadoi 10 10170S0047404508080986Small talk high stakes Interactional disattentiveness in thecontext of prosocial doctor-Patient interactionD O U G L A S W M AY N A R DDepartment of Sociology1180 Observatory DriveUniversity...

daveknot.files.wordpress.com/2009/05/doctor-patient-sma...l-discourse.pdf
  • Author: none
  • Size: 216 KB
  • Created: Mon Oct 13 16:19:37 2008
Pages: 6
Patient z files21may09 Hdpcu And Patient Safety Fiesta

21May09 - HDPCU and Patient Safety Fiesta Buangkok Green Medical Park10 Buangkok ViewSingapore 539747Tel 65 6389 2000Fax 65 6389 1050www imh com sgFOR IMMEDIATE RELEASETHE HIGH DEPENDENCY PSYCHIATRIC CARE UNIT HOW INTENSIVE CARE ANDHEALTH EDUCATION TRANSLATE TO BETTER HEALTHCARE AT THE INSTITUTE OFMENTAL HEALTHHDPCU the High Dependency Psychiatric Care Unit at Ward 31A officially opens on21 May 20...

imh.com.sg/uploadedFiles/Newsroom/News_Releases/21May09...fety Fiesta.pdf
  • Author: none
  • Size: 48 KB
  • Created: Wed Aug 26 17:23:36 2009
Pages: 1
Patient z filesPatient Centered Medical Home

Patient Centered Medical Home Keith S Defever M D F A A F PThomas G Graves M D F A A F PDennis M Ramus M D F A A F PP Gregory Rowsell M D F A A F PAnna K Demos M D F A A F PEileen R Hopman M D F A A F PPaul D Paonessa M DSusan Grabowski D OBay Area Family Physicians P C34301 23 Mile Road Suite 100New Baltimore MI 48047Telephone 586 725-1770Fax 586 725-4080PATIENT CENTERED MEDICAL HOMEPATIENT PROVI...

bayareafp.com/pdf/Patient Centered M...edical Home.pdf
  • Author: none
  • Size: 101 KB
  • Created: Fri Oct 16 17:05:22 2009
Pages: 2
Patient z filesPatient Partnership Plan

Microsoft Word - Patient PARTNERSHIP PLAN.docx Frank C Candela M D F A C SDavid Z Schreier M D F A C SA Medical CorporationDiplomates American Board SurgerySurgical OncologyGeneral and Laparoscopic SurgeryPatient Partnership PlanDear PatientWelcome to our practice We intend to provide you with the best surgical care and service that you expectand deserve Achieving your best possible health require...

westvalleysurgeons.com/wp-content/uploads/2012/09/Patie...ership-Plan.pdf
  • Author: none
  • Size: 70 KB
  • Created: Thu Aug 2 15:34:03 2012
Pages: 1
Patient z filesPatient Information Sheet Front

Patient Information THE EYE CENTERMedical Surgical Eye CarePatient InformationName Last Name First Name Middle InitialSoc Sec Date of Birth Sex M FMinor Single Married Long Term Partner Divorced Widowed SeparatedAddress Home Phone City State Zip Out of Town Address if any Employer if any Business Phone Business Address Occupation Emergency Contact Name Relationship PhoneResponsible PartyChe...

youreyecenter.com/forms/Patient-Information-sheet-front...sheet-front.pdf
  • Author: none
  • Size: 74 KB
  • Created: Tue Nov 17 11:20:31 2009
Pages: 3
Patient z filesPatient Information And Complaint Form

Microsoft Word - Patient Information & Complaint Form.doc Silver Lane Surgery 1 Suffolk Court Yeadon Leeds LS19 7JNTelephone 0844 4773780 Fax No 0844 4773811PATIENT INFORMATION COMPLAINT FORMIf you have a complaint or concern about the service you have received from the doctors or any of thepersonnel working in this practice please let us know We operate a practice complaint procedure as part ofan...

yeadontarnmedicalpractice.nhs.uk/pdf/patient-informatio...plaint-form.pdf
  • Author: none
  • Size: 185 KB
  • Created: Tue May 29 13:38:34 2012
Pages: 1
Patient z files15 Patient Medical Release Authorization

Microsoft Word - 15 Patient medical release authorization.doc Patient MEDICAL RECORD RELEASE AUTHORIZATIONDate Patient Name Birthdate I hereby authorize the release of my personal health information to the following relativesor individualsName Relationship Name Relationship Name Relationship Name Relationship Regarding phone messages please check yes or no Yes No Premier may leave messages o...

newlifebariatricsurgery.com/wp-content/uploads/2012/02/...thorization.pdf
  • Author: none
  • Size: 70 KB
  • Created: Thu Mar 15 17:53:58 2012
Pages: 8
Patient z filesNew Patient Intake1

Microsoft Word - New Patient Intake.docx New Patient IntakeName DateAge Date of birth Sex Male Female TransgenderAddress City State Zip Telephone Home Work Cell Email Emergency Contact RelationshipTelephone Home Work Cell How did you dear about Dr Nagelkirk NOTE Holistic and preventative health care is enhanced dramatically when the physicianhas a complete picture of the Patient physically ...

apisintegrative.com/wp-content/uploads/2013/04/New-Pati...ent-Intake1.pdf
  • Author: none
  • Size: 186 KB
  • Created: Fri Jan 31 14:03:56 2014
Pages: 2
Patient z filesNew Patient Form

Patient Information Questionnaire First MiddleLast Name Name InitialSocial SecurityAddressCity State ZipHome PhoneCell Phone EmailWork PhoneEmergencyContact Name PhoneFor appointment confirmation which phone should we call Check oneHome Work or Cell Sex MF AgeDate of BirthMarital Status Single Married Divorced Separated Widow Employment Status F T P T Retired Student Unemployed Who referr...

laurarampil.vpweb.com/upload/New P...atient Form.pdf
  • Author: none
  • Size: 71 KB
  • Created: Mon Mar 7 12:02:42 2011
Pages: 3
Patient z filesEmerging Issues And Challenges For Improving Patient Safety In Mental Health Handout

Emerging Issues and Challenges for Improving Patient Safety in Mental Health: A qualitative analysis of key informants’ perspectives An agency of the Provincial Health Services AuthorityEmerging Issues and Challenges for Improving Patient Safety in Mental Health AQualitative Analysis of Key Informants PerspectivesTracey A Brickell D Psych Carla McLean M A Kristen E Howard B ABritish Columbia Men...

patientsafetyinstitute.ca/English/research/commissioned...h (Handout).pdf
  • Author: none
  • Size: 60 KB
  • Created: Mon Sep 15 14:12:04 2008
Pages: 2
Patient z filesPatient Information Update Form2

Microsoft Word - Patient INFORMATION update form2.doc Patient INFORMATIONNameBirthdateAgeAddressCityStateZipPhone H C Social Security last 4-digits E-mail address Employer Occupation Phone W Sex Male Female Do you live alone Yes NoSingle Married Widowed DivorcedSpouse s Name PhoneDo you Smoke Yes No If yes how muchDo you operate a motor vehicle Yes NoHobbiesPrimary Care Physician Date of last e...

robbinseye.com/documents/robbinseye/PATIENT INFORMATION...pdate form2.pdf
  • Author: none
  • Size: 66 KB
  • Created: Mon Apr 9 10:27:54 2012
Pages: 2
Patient z filesKelvington Hospital Patient Guide 03 10

http://sharepoint/CCO/Shared Documents/KTHR Branding/Branded Public Brochures/BR-10060 Kelvington Hospital Patient Guide 03-10. FOR YOUR CONVENIENCE PREPARING TO GO HOMEMail Flowers It is important for you and your family to start thinkingabout returning home while you are still in hospitalMail is delivered daily and flowers will be Talk to your doctor and nurses about any concerns youdelivered up...

kelseytrailhealth.ca/HSL/Kelvington/Documents/Kelvingto...Guide 03-10.pdf
  • Author: none
  • Size: 71 KB
  • Created: Thu Mar 25 09:30:53 2010
Pages: 3
Patient z filesPatient Safety Conference & Cpd Study Day Abstract Competition 1

Patient Safety Conference and CPD Study Day Abstract Competition Patient Safety Conference CPD Study Day1st October 2014 2nd October 2014Waterfront Hall BelfastThis year the Patient Safety Conference and the CPD Study Day will run back to back at theWaterfront Hall in Belfast Trainees are invited to submit abstracts for both events taking place onthe 1st and 2nd October 2014Trainees are welcome to...

imperial-anaesthesia.org.uk/uploads/files/Patient Safet...mpetition_1.pdf
  • Author: none
  • Size: 224 KB
  • Created: Mon Jun 23 11:49:39 2014
Pages: 1
Patient z filesAuthorization To Obtainrelease Patient Health Information Pbh

Patient Label 2511 M Ave Suite BAnacortes WA 98221Phone 360 299-4297Fax 360 299-4294AUTHORIZATION TO OBTAIN RELEASE Patient HEALTH INFORMATIONI authorize Island Hospital to Obtain Information Release Information Mutual Exchange of InformationDates of service for records requested from to Family Members Verbal exchange of information Psychiatric medical notesSchool Education records Juvenile court ...

https://islandhospital.org/Uploads/Archived_Files/Autho...ation---PBH.pdf
  • Author: none
  • Size: 119 KB
  • Created: Tue Jan 31 12:54:22 2012
Pages: 2
Patient z files1 Patient Information Sheet Re

Patient INFORMATION SHEET Patient INFORMATION SHEETName Date Address Home Phone City State Cell Phone Zip Sex Male Female Soc Security Date of Birth Age Email address Race Caucasian Black Hispanic OtherPatient s Employer Occupation Employer s Address City State Zip Work Phone Marital Status Married Single Divorced Widowed Spouse s Name DOB EMERGENCY Contact Phone Patient Primary Care ...

lowbackpain.com/cms/gallery/1-Patient-Information-Sheet...on-Sheet-RE.pdf
  • Author: none
  • Size: 93 KB
  • Created: Tue Dec 4 09:40:40 2012
Pages: 1
Patient z filesMdtpatientinformationleafletfinal2011

Microsoft Word - MDT Patient information leaflet final 2011 The Breast Care Specialist TeamThe specialist breast care team members in the breast unit combine healthcareprofessionals known as the breast multidisciplinary teamEach member of the team contributes to your treatment and care meeting on aweekly basis to discuss planning tests the results of tests possible treatment plansand Patient conce...

cancerlancashire.org.uk/CubeCore/.uploads/website_conte...etfinal2011.pdf
  • Author: none
  • Size: 144 KB
  • Created: 5/16/2011 17:1:14
Pages: 3
Patient z filesCv Patient Panel Website April 2013 1

CV Patient Panel Website - April 2013 Cardiovascular Research Patient Panel websiteSheffield Teaching Hospitals NHS Foundation TrustPatient InvolvementThe Cardiovascular Research Patient Panel is part of the Academic Directorate of Cardiology andCardiothoracic Surgery within Sheffield Teaching Hospitals NHS Foundation Trust STH The Panel ismade up of men and women who for various reasons have an i...

sheffieldclinicalresearch.org/download/clientfiles/file...ril 2013(1).pdf
  • Author: none
  • Size: 31 KB
  • Created: Thu May 2 09:32:58 2013
Pages: 4
Patient z filesPatient Information

Patient Information.qxp Patient InformationConfidential Information Important for Our Files and Your HealthPatient Date of BirthHome Address TelephoneCity State Zip CodeE-mail Cell PhonePatient Employed by OccupationBusiness AddressBusiness Telephone Social Security NoName of SpouseSpouse Employed by Business TelephoneBusiness AddressDo you have medical insurance Are you the insured Or a dependent...

silvermanpodiatry.com/patient....information.pdf
  • Author: none
  • Size: 24 KB
  • Created: Tue May 26 14:41:47 2009
Pages: 1
Patient z filesRefugee Pgy3 Patient Chart

Patient CHART Temp 37 2 BP 120 80 HR 84Patient Name Mendoza Patient AgeHistory Number 022557 Chart Number 086254RR 14 HT WT 75 KgComplaint Follow-up to discuss results of the recent colonoscopyNurse s signature Diane WaltersCopied DictatedReviewed w attending......

https://pages.shanti.virginia.edu/fmchallpatient/files/...ient.Chart_.pdf
  • Author: none
  • Size: 19 KB
  • Created: Tue Jan 24 12:31:50 2012
Pages: 1
Patient z filesJoint Evd Patient Management Process 28 Oct 2014

EBOLA VIRUS DISEASE Patient MANAGEMENT CORE PROCESS Revised October 28 2014Outpatient Clinic Inter-hospitalNeighbor Islands Oahu onlyanywhere Patient Transfer3 1 2 1 2 2 1 1 1 2Walk-In EMS Walk-In EMS Walk-InNote 1EMS contacthospital prior toHospital with greenarrivalOpen Corridorflag on WebEOCOutpatient Clinicor other nonhospital EMS contactHCF hospital prior toarrivalIdentify Exposure Other Comm...

hah-emergency.net/Shared Documents/JOINT EVD Patient Ma...28 OCT 2014.pdf
  • Author: none
  • Size: 129 KB
  • Created: Tue Oct 28 21:28:08 2014
Pages: 15
Patient z filesPsychiatric Emergencies How To Accurately Assess And Manage The Patient In Crisis

Psychiatric Emergencies How to Accurately Assess and Manage the Patient in Crisis 2009 189 pages Deborah Antai-Otong R N 0982039824 9780982039823 Pesi2009DOWNLOAD http bit ly 1vV2pTg http goo gl RRyWX http en wikipedia org w index php search Psychiatric Emergencies 3A How to Accurately Assess and Manage the Patient in CrisisPsychiatric Emergencies now in its second edition presents an easy-to-read...

ajewuzon.files.wordpress.com/2014/06/psychiatric-emerge...t-in-crisis.pdf
  • Author: none
  • Size: 86 KB
  • Created: Wed Feb 9 11:30:47 2011
Pages: 37
Patient z filesTap 13 Confidentiality Of Patient Records For Alcohol And Other Drug Treatment 103

Confidentiality of Patient Records for Alcohol and Other Drug Treatment Technical Assistance Publication TAP Series 13DHHS Publication No SMA 95-3018Printed 1994U S DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health ServiceSubstance Abuse and Mental Health Services AdministrationRockwall II 5600 Fishers LaneRockville MD 20857Chapter 1 Overview of Federal Alcohol and Other Drug Confidentiality La...

lib.adai.washington.edu/clearinghouse/downloads/TAP-13-...eatment-103.pdf
  • Author: none
  • Size: 469 KB
  • Created: Tue Nov 17 19:00:33 2009
Pages: 2
Patient z filesMost Recent Patient Information Jan 2013

Microsoft Word - Most Recent Patient Information Jan 2013 MEDAC HEALTH SERVICES P A4402 Shipyard Boulevard Wilmington NC 28403 910-791-00751442 Military Cutoff Road Wilmington NC 28403 910-256-60888115 Market Street Wilmington NC 28411 910-686-1972MEDAC CORPORATE HEALTH4402 Shipyard Boulevard Wilmington NC 28403 910-452-7000Today s Date Patient INFORMATION Method of PaymentThis Form Must Be Comple...

https://medachealth.com/wp-content/uploads/2013/06/Most...on-Jan-2013.pdf
  • Author: none
  • Size: 94 KB
  • Created: Wed Jun 5 08:38:35 2013
Pages: 5
Patient z filesKprs New Patient Set 2014 Writtable

Microsoft Word - KPRS NEW Patient SET 2014.docx Thank you for choosing Keystone Plastic and Reconstructive Surgery Please make changes to any information filled out improperlyor fill in any missing information on the following form to ensure the fastest and best healthcare servicePATIENT INFORMATIONDate Referred byName SSBirth Date AgeHome AddressCity State ZipHome Phone Mobile PhoneEmail addressM...

keystonesurgery.com/documents/KPRS-NEW-PATIENT-SET-2014...4-writtable.pdf
  • Author: none
  • Size: 246 KB
  • Created: Sun Jun 22 20:23:17 2014