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INTENSIVE OUTPATIEN T PROGRAM. PATIENT HISTORY FORM. Patient Name : Patient Label. DOB: SEX: EM BF. Marital Status: 5 S Q fill B Sep 5 D E W.

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For information about your medical record, please see this Medical Records page or call (984) 974-3226. If you would like to request a copy of information in a medical record, please FAX a completed authorization form to (984) 974-0474.

North Carolina General Statutes §90-411 Inclusive of searching, handling, copying, and mailing costs: $0.75 for first 25 pages. $0.50 for pages 26-100. $0.25 for pages over 100.

The best way to make your written request is to click on each request you want to make below, which will allow you to access our form. You may also call us at 984-974-3226 to request that we provide you with a copy of the forms you need to make your requests.

North Carolina's medical records laws hold all privileged patient medical records as confidential, available to pharmacists when necessary. In cases where a medical professional suspects child abuse, however, that person is required to report these findings to law enforcement.

Greet the patient by name and introduce yourself. Ask, “What brings you in today?” and get information about the presenting complaint. Collect past medical and surgical history, including any allergies and any medications they're currently taking. Ask the patient about their family history.

In general, a medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently stopped taking.

NOTE: Records must be retained 11 years after last encounter at hospital.

Novant Health was formed July 1, 1997 by the merger of Carolina Medicorp of Winston-Salem, North Carolina and Presbyterian Health Services of Charlotte, North Carolina. We've continued to grow and reach out to new communities through our medical centers. 1891 - Twin City Hospital opened in Winston-Salem, NC.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232