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Type of form: Registration and history form
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250 per pack
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Size: 8 1/2″ x 11″
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Binding type: Loose
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Number of parts: 1
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Helps ensure reimbursement with primary and secondary insurance information, and HIPAA compliant authorizations for insurance and Medicare
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Strong certification by patient that they are responsible for accuracy and completeness of health history provides legal backup
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Gathers full clinical documentation including complete family and personal medical history
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Screens patient for over 70 common symptoms arranged to your ROS



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