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4.8 out of 5

163 votes

The document is a comprehensive patient intake form for Balanced Well Health Center, collecting personal, insurance, medical, and social history information from patients. It includes sections for patient demographics, accident details, insurance information, medical history, consent to treatment, and privacy notice. The form emphasizes the importance of accurate health information for effective treatment and outlines the patient's rights regarding their protected health information.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (163 Votes)

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