Lactation consultants winter springs fl form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, address, city, state, zip code, and phone number. Ensure all details are accurate for effective communication.
3. Next, indicate the patient's birthdate and gender. This information is crucial for proper identification and treatment planning.
4. In the 'Insurance Information' section, provide details about the referring physician and insurance carrier. Include any relevant subscriber information and coverage codes.
5. Complete the 'Lactation Diagnosis' section by selecting appropriate ICD codes that correspond to the patient's condition. This helps in billing and insurance claims.
6. Finally, review all entered information for accuracy before signing at the bottom of the form. Your signature authorizes payment assignment to the healthcare provider.

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