Get Wv Pulmonary Associates Of Charleston New Patient Form 2019-2025

Completing the WV Pulmonary Associates of Charleston New Patient Form online is a straightforward process designed to streamline your registration. This guide will provide you with detailed instructions on how to successfully fill out each section and field of the form, ensuring you provide all necessary information for a smooth visit.

Follow the steps to fill out the form accurately

1. Click ‘Get Form’ button to obtain the form and open it.
2. Begin by entering the referring physician's name and their phone number in the designated fields at the top of the form. If you do not have a referring physician, you may leave this section blank.
3. Next, fill in the primary care physician's details, including their name and phone number. This information helps the medical team coordinate your care effectively.
4. Proceed to the insurance information section. Start by entering the name of your primary insurance provider along with your policy number and the name of the insured or employee.
5. Indicate the relationship of the insured to you, then proceed to fill in the identification number and group number in the respective fields.
6. If you have secondary insurance, provide the necessary details similarly by filling in the insurance name, policy number, name of the insured, relationship to patient, ID number, and group number.
7. In the signature area, the patient must sign and date the form. If the patient is a minor, a parent or guardian must provide their signature alongside their relationship to the patient.
8. Review the sections regarding consent and authorization. Ensure you read and understand each item before selecting the appropriate boxes based on your preferences and circumstances.
9. Complete the tobacco, alcohol, and drug use sections by selecting the appropriate options and providing any necessary descriptions. This section is crucial for understanding your health background.
10. If you need to provide additional information regarding hazardous material exposure, fill out the provided space accurately.
11. Finally, check the boxes for any medical records you grant permission to be released. This helps streamline your care process by ensuring relevant information is shared appropriately.
12. After thoroughly reviewing the completed form for accuracy, save your changes, download, print, or share the form as needed.

Complete your WV Pulmonary Associates of Charleston New Patient Form online today!