Ziekenhuis Toelatingsbrief
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De beste manier om een Ziekenhuis Toelatingsbrief te maken? Check direct dit professionele Ziekenhuis Toelatingsbrief template!
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How to write a Hospital Admission Letter? Download this Hospital Admission Letter template that will perfectly suit your needs.
Our collection of online health templates aims to make life easier for you. Our site is updated every day with new health and healthcare templates. By providing you this health Hospital Admission Letter template, we hope you can save precious time, cost and efforts and it will help you to reach the next level of success in your life, studies or work!
PERSONAL AND ADMINISTRATION DETAILS Mr Surname (family name): First name(s): Date of birth: Mrs Ms Miss Mstr Dr Preferred name: dd / mm / yyyy Gender: Male Female NHI: Residential address: Postal address: Email address: Telephone: (Home) New Zealand resident: Yes (Business) (Mobile) No Ethnicity: European / Maori / Pacific Island / Asian / Middle Eastern / Latin American / African / Other General Practitioner (Name): ( Please circle one or more) Telephone: Medical Centre: NEXT OF KIN/CONTACT PERSON Name: Relationship to patient: Address: Telephone: (Home) (Business) (Mobile) PAYMENT DETAILS How will your procedure be paid for Tick and complete as many as applies: Health insurance (personal expenses such as telephone calls are excluded) Name of Insurer: Insurance Plan Name: Have you obtained “prior approval” for payment Yes No ACC (personal expenses such as telephone calls are excluded) Membership No: Approval No: (Bring your prior approval letter) DHB (personal expenses such as telephone calls are excluded) Paid personally If you are paying for the procedure yourself, you may be asked to pay an estimated deposit 3-5 days before admission..
This Hospital Admission Letter is intuitive, ready-to-use and structured in a smart way. Try it now and let this Hospital Admission Letter sample inspire you.
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