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Get London, Bethlem Hospital Patient Admission Registers And ...

PATIENT REGISTRATION FORM Date of Birth Please ensure these forms are received by the hospital at least 7 days prior to admission. Sex Age Room No. TO BE COMPLETED BY PATIENT OR USE LABEL Have you been admitted to this Hospital previously? No Yes Year: Method of payment for this admission: Private Health Insurance Self Funded Workcover TAC/MVIT(WA) DVA Other: How.

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