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- FL Therapy Network Patient Intake Form 2022
Get FL Therapy Network Patient Intake Form 2022-2024
( 88 8) 550- 880 0 x 1 Facility / Group Name TIN Number Facility / Group Address (where services will be rendered) Facility / Group NPI City State Contact Person Fax this request to: Phone Zip Fax Treating Therapist Name (rendering) Treating Therapist NPI Referring Provider Name Referring Provider NPI Patient Last Name Patient First Name Patient ID Patient County Patient Date of Birth (mm/dd/yyyy) Line of Business Medicare Medicaid Medicaid Healthy Kids Plac.
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INTAKE FAQ
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Patient intake forms are like information sheets you fill out at the doctor's office. They ask about your health, personal details, and medical history during your first visit. These forms help create a full picture of your health for the healthcare provider.
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TNFL is a licensed Florida Third Party Administrator which provides Outpatient Therapy Network Services for Florida Managed Care Health Plans throughout the State. TNFL currently covers over 2.9 million lives through various Florida Health Plans.
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