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  • 7?im!n - Inova

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Ollected By: SIGNATURE REQUIRED BELOW. ATTACH INSURANCE CARDS STAT BILL: SEX (M-Male F-Female) DATE OF BIRTH (mm/dd/yy) SOCIAL SECURITY # PHONE (Other) CITY PRIMARY BILLING PARTY POLICY # POLICY # GROUP#/ENROLLMENT CODE GROUP#/ENROLLMENT CODE INSURANCE ADDRESS INSURANCE ADDRESS GUARANTOR SS# RELATIONSHIP TO PATIENT SEND RESULTS TO: FAX TO Physician s Name Physician s Signature TEST NO. FIRST ADDITIONAL TESTS ICD-9 ALPHABETICAL LISTING ANA (REFLEX) BILIRUBI.

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How to fill out the 7?IM!n - Inova online

This guide provides clear instructions on how to successfully fill out the 7?IM!n - Inova form online. Whether you are a first-time user or seeking to improve your familiarity with the form, this guide is designed to assist you in completing it efficiently.

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  1. Use the ‘Get Form’ button to access the 7?IM!n - Inova form. By doing so, you can open the document in your editing interface.
  2. Begin by entering the date and time the specimen was collected. This includes providing the name of the person who collected the specimen.
  3. Fill in the required sections including the patient's full name, date of birth, social security number, and contact information.
  4. Indicate the sex of the patient by selecting either 'M' for male or 'F' for female.
  5. For billing purposes, specify the primary and secondary billing parties by entering their respective insurance details and policy numbers.
  6. Enter the relationship of the guarantor to the patient and include their social security number.
  7. Designate where the lab results should be sent, including options for faxing to a physician and providing their name for reference.
  8. Select the tests to be performed from the alphabetical listing provided. Make sure to check the appropriate boxes for the tests needed.
  9. Once all the information has been filled out accurately, review the form for completeness.
  10. Finally, save changes, download, print, or share the completed form as needed.

Complete your 7?IM!n - Inova form online today.

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U.S. News & World Report has again ranked Inova Fairfax Hospital #1 in the Washington, DC metro area, as well as #1 in the state of Virginia.

Inova Fairfax Hospital offers Northern Virginia's only level 1 trauma center for treating the most critically injured patients. Inova Fairfax Hospital has a robust organ transplantation program, including heart, lung, kidney, and pancreas transplant services.

Thus, the Inova name is a play on “innovation” and “Northern Virginia” and is pronounced with a short “i” (same as the word “innovation”).

Inova Fairfax Hospital (IFH) is a 923-bed tertiary care hospital campus providing most medical and surgical specialties and houses Northern Virginia's only Level 1 Trauma Center and the nation's fifth-busiest obstetrics program (with nearly 12,000 live births in 2006).

1. Inova Fairfax Medical Campus – 923 beds. The Inova Fairfax Medical Campus, located in Falls Church, is the biggest hospital in Virginia, with 923 beds.

The logo, which depicts two figures, represents the fact that every step of the healthcare journey is taken together; whether it's a provider comforting a patient, a doctor collaborating with a nurse or family member supporting a loved one.

Inova Fairfax Hospital is Northern Virginia's only Level 1 Trauma Center, and Inova Loudoun Hospital is Loudoun County's first and only designated trauma center.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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