Shift select atrium 2025

1. Click ‘Get Form’ to open the shift select atrium in the editor.
2. Begin by entering the date at the top of the form. This is essential for tracking your submission.
3. Fill in the patient information section, including marital status, gender, race, date of birth, and social security number. Ensure accuracy as this data is crucial for patient identification.
4. Complete the address fields with street, city, state, and zip code. Also, provide email and phone numbers for home, cell, and work to facilitate communication.
5. In the insurance information section, remember to submit a copy of both sides of the insurance card as instructed.
6. Provide details about the referring provider and practice information. Include their contact details for seamless coordination.
7. Indicate what service you are requesting by checking the appropriate boxes in that section.
8. Finally, review all entered information for accuracy before submitting your form through our platform.

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