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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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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
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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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