Get Patient Details And Enrolment Form - Bakerfield Co

Filling out the Patient Details and Enrolment Form for Bakerfield Co online is a straightforward process that ensures you provide all necessary information for your healthcare. This guide will walk you through each section of the form to make your experience as smooth as possible.

Follow the steps to accurately complete the form.

1. Press the ‘Get Form’ button to access the PATIENT DETAILS AND ENROLMENT FORM. This will open the form in your online editor.
2. Begin by filling out your personal details. Enter your surname, legal first name, and preferred first name. If you have any other known names, include those as well. Provide your date of birth in the specified format (Day/Month/Year) and your NHI number if applicable.
3. Select your gender from the available options and indicate your country of birth. Provide your residency status and physical address. If your postal address is different, make sure to include that as well.
4. Fill in your home and mobile phone numbers. If you have a Community Services Card or High User Card, provide the numbers and their expiry dates.
5. Complete the next of kin section by entering their name and phone number, and select your ethnicity from the listed categories. Make sure to specify if your ethnicity is not listed.
6. Input your employment details, including your company name, occupation, and company address. Also, provide a work phone number.
7. Indicate if you wish to have your notes sent to your own doctor, and if applicable, include their details as requested.
8. In the enrolment section, confirm if you wish to enroll at the clinic. If yes, be prepared to request an enrolment form from the receptionist.
9. Check the eligibility criteria for enrolment and confirm that you meet one of the requirements. This includes provisions for New Zealand citizens, Australian citizens, work permit holders, and refugees.
10. Read through the agreement to enroll. Ensure that you understand all terms and implications regarding your enrolment with the practice and the Primary Health Organisation. Confirm your agreement by signing the form.
11. If necessary, have a parent or caregiver sign the form if you are under 16 years old. Provide the details of the authority if you are signing on behalf of someone else.
12. Once all sections are complete, remember to save your changes. You can then download, print, or share the completed form as needed.

Complete your PATIENT DETAILS AND ENROLMENT FORM online today for efficient healthcare management.