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GUARANTOR (If older than 18, patIent will be listed as guarantor

GUARANTOR (If older than 18, patIent will be listed as guarantor 2025

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4.8 out of 5

143 votes

The document is a comprehensive Patient Information Form used by Generations Pediatrics & Internal Medicine. It collects essential personal, insurance, and medical history details from patients, including demographics, emergency contacts, medication lists, allergies, immunizations, and family medical history. Additionally, it outlines financial policies regarding payment for services and the privacy policy concerning the handling of protected health information (PHI) under HIPAA regulations.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the LAST NAME and FIRST NAME of the guarantor. Ensure that this information matches official identification.
Fill in the DATE OF BIRTH and MIDDLE INITIAL of the guarantor. This is crucial for verifying identity.
Indicate the RELATIONSHIP TO PATIENT. This helps clarify the connection between the patient and the guarantor.
Provide the SOCIAL SECURITY NUMBER (SS#) of the guarantor, ensuring accuracy for billing purposes.
Complete the MAILING ADDRESS, including CITY/STATE and ZIP CODE, to ensure proper communication.
Enter contact numbers: MOBILE PHONE, HOME PHONE, and WORK PHONE for easy reach regarding any inquiries or updates.
Lastly, review all entered information for accuracy before submitting to avoid delays in processing.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who cant be your guarantor?

A parent or legal guardian cant act as guarantor when applying on behalf of a child or dependent adult.

Who is the guarantor on a patient account?

Guarantor: The person responsible for payment of rendered services. The guarantor is customarily the person bringing the patient in for treatment. This person is not necessarily the same as the subscriber. Health Care Provider: A person who is trained and licensed to give health care.

Can a guarantor be 18?

The guarantor must be over the age of 21 and under 75 years old. As a guarantor, you also need to have a reasonably good credit history. You will need to show that you have an income or savings and the ability to repay debt if the borrower cant.

Who would be considered a guarantor?

A guarantor is an individual that agrees to pay a borrowers debt if the borrower defaults on their obligation. A guarantor is not a primary party to the agreement but is considered to be an additional comfort for a lender. A guarantor will have a strong credit score and earn sufficient income to meet the obligation.

How old should a guarantor be?

A guarantor can be any person over the age of 18 years with a good credit report and sufficient income. A guarantor doesnt live on the property. Sometimes, an applicant may work with a lease guarantor company, which agrees to pay if the tenant defaults.