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Get and Sign Patient Intake Form  MedStar Health

Get and Sign Hospital Intake Form

Use a hospital intake form template to make your document workflow more streamlined.

Reconciliation are requIred Provider should check No Changes box Initial and date. E. V S T Providers lnll Date of Service No Changes n/a V 4. S 5. I 6. PAGES 1 2 3 FOR PATIENT USE V 7. S 8. I 9. PAGE 4 ORIGINATING DEPARTMENT COPY Name PATIENT REGISTRATION GEORGETOWN PHYSICIANS GROUP Washington DC 20007 Last First Middle Address Date of Birth Medical Record Number Age Sex Race Phone SSN M. Iii PRINT OR USE PATIENT LABEL OUTPATIENT SUMMARY LIST Firsi Lasl MR PLEASE PRINT. PRESS FIRML Y. GUH...
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Music hi my name is Dr. Bradley moats and I'm a board-certified fellowship trained spine surgeon if you have chronic back or leg pain don't delay seeking medical attention the orthopedic team here at Megastar hEvalth can help most common conditions patients see me for is for neck pain or lower back pain and a lot of times it'll radiate down their arm or their leg the main thing I want to hear from the patient is their story and what actually led to their pain, and then I try to characterize it further in terms of exact location severity and take it from there and see if it matches and correlates with their imaging studies spine surgery in general can be very daunting for patients understandably, so it can be a large surgery, and it takes a big toll on the body I try to put them in ease the best I can by explaining their pathology on MRI and showing them exactly what is causing their pain, and then I also try to explain how we would address that surgically with use of a spine model the

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