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Get Er Hospitalization Form

ER / HOSPITALIZATION FORM PATIENT INFORMATION FAMILY NAME GIVEN NAMES DATE OF BIRTH GENDER CARD NUMBER PAYER CASE INFORMATION INPATIENT DAYCARE ER Only DIAGNOSIS AETIOLOGY ( Pls indicate exact cause).

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  5. Indicate the date to the record using the Date feature.
  6. Click on the Sign button and make a signature. You will find 3 available options; typing, drawing, or capturing one.
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  8. Select Done in the top right corne to save the record. There are various options for getting the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

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Keywords relevant to NAS ER/Hospitalization Form

  • payer
  • hospitalization
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  • TEL
  • physicians
  • daycare
  • medications
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