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Demos Med Questionnaire 05 23 161 copy

Demos Med Questionnaire 05 23 161 copy 2025

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The document is a Medical Questionnaire designed for patients visiting Temecula 24 Hour Urgent Care. It collects personal information, medical history, and consent for treatment while outlining privacy practices under HIPAA. The questionnaire includes sections for symptoms, emergency contact details, and financial policies regarding payment responsibilities and insurance claims. It emphasizes patient rights concerning their health information and the clinic's commitment to maintaining privacy.

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Versions	Form popularity	Fillable & printable
2011	4.8 Satisfied (208 Votes)

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