Parislakeshealthgroup.com

WELCOME TO OUR OFFICE! We welcome you to our Paris …

WEBPatients that do not have any insurance, Medicare or Medicaid coverage are considered “private pay” patients. These patients are expected to pay the full amount of the charges …

Actived: 3 days ago

URL: https://parislakeshealthgroup.com/wp-content/uploads/2021/06/Primar-Care-WELCOME-TO-OUR-OFFICE-2021.pdf

www.parislakeshealthgroup.com

WEBwww.parislakeshealthgroup.com

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Office Manager: Mishayla Brewer (903) 609-1065

WEBOffice Manager: Mishayla Brewer (903) 609-1065 WHEN YOU ARE SEEN BY AN EMPLOYEE of the Paris Lakes Health Group: You Have the Responsibility To:

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PATIENT AUTHORIZATION TO DISCLOSE PROTECTED HEALTH …

WEBalois pauls, m.d. carolyn robinson-cowley, fnp-bc st 2675 41 st se, suite 102 paris, texas 75462 phone: 903-739-7700 │ fax: 903-739-7989 patient authorization to disclose …

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PATIENT MEDICAL HISTORY INTAKE FORM

WEBPage 1 | Patient History Intake Form_Rev.082818 _____ PATIENT MEDICAL HISTORY INTAKE FORM

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Authorization and Consent to Treat

WEBAuthorization and Consent to Treat AUTHORIZATION OF ASSIGNMENT OF BENEFITS, RELEASE OF INFORMATION AND CONSENT FOR TREATMENT: I hereby authorize …

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The purpose of this information:

WEBRecords Release Request To: _____ Ph:_____ _____ Fax:_____ _____ I hereby authorize the release of copies of my medical records and request that they be sent to:

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