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Get and Sign Alliance Authorization Form

Get and Sign Alliance Authorization Form

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Name: CALIFORNIA IRONWORKERS Subscriber Name: ________________________ D.O.B: ___________ ID Number:________________ Patient’s Name: _______________ D.O.B: _______ ****PLEASE ATTACH COPY OF MEDICAL CARD**** Address: ____________________________________________City: ______________________________ State: ______ Zip: ________________ Medicare Primary:  Yes Phone# of Subscriber: ______________________________  No Other Insurance:  Yes  No Requesting Physician Information Requesting...
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Well welcome to the Center for acute rehabilitation of pacific alliance medical center my name is Marianne Camus, and I'm the director the mission of the rehab center is to return patients who have suffered debilitating conditions to their highest level of function civilized Medical Center is the oldest Hospital here in Los Angeles it evolved from the French hospital as a greater tradition physician here have been here for a very long time at our acute rehab unit retreat patients who need to go back home and regain function our goal is to provide rehabilitative services for our patients such as physical therapy occupational therapy or speech therapy our patients come to us after suffering major debilitating events and conditions they need that extra step to get back home my patient here in the Curia have been mostly stroke patients the other two major groups a page in the country have programs are traumatic brain injury patients suffer from a major injury and respond according to patie

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