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New Patient Info - Barry Brace DMD & Associates 2025

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The document is a comprehensive New Patient Information form for children at AIR Care Allergy Immunology & Respiratory Care PA. It collects essential details about the patient, including personal information, medical history, family background, emergency contacts, pharmacy information, and consent for treatment and financial agreements. The form also includes sections for insurance information and privacy practices.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's full name and preferred name in the designated fields. Ensure accuracy for identification purposes.
Fill in the date of birth, mailing address, and contact numbers. Select the appropriate gender option.
Provide information about the referring doctor and primary care physician, including their contact details.
Indicate if any family members have been seen before and provide details if applicable.
Complete the sections regarding parental information, including marital status and insurance details.
Fill out emergency contact information for situations when you cannot be reached.
Provide pharmacy information to facilitate prescription refills as needed.
Complete the child medical history section thoroughly, noting any allergies, medications, or past medical issues.
Review all entered information for accuracy before submitting your form through our platform.

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