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Arizona Ophthalmic Outpatient SurgeryArizona Ophthalmic Outpatient Surgery

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Patient Forms

Instructions for Pre-Registration / Instrucciones para Pre-Registro

PATIENT PRE-REGISTRATION AND INSTRUCTIONS

Print Both Sheets – First page is Read Only and includes instructions for surgery.

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NOTICE OF PRIVACY PRACTICES AND ADVANCED DIRECTIVES

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FINANCIAL NOTICE

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REGISTRATION AND PATIENT DEMOGRAPHIC (PLEASE FILL OUT AND BRING WITH YOU TO YOUR VISIT)

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PRE-REGISTRO Y INSTRUCCIONES DEL PACIENTE

IMPRIMIBLE DOS PAGINAS

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AVISO DE PRACTICAS DE PRIVACIDAD Y DIRECTORIOS MEDICOS AVANZADOS

SOLO LECTURA

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DERECHOS Y DEBERES DE LOS PACIENTES

SOLO LECTURA

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NOTIFICACION DEL PROPIETARIO DEL MEDICO

SOLO LECTURA

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NOTIFICACION FINANCIERA

SOLO LECTURA

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REGISTRO Y PACIENTE DEMOGRAFICO (POR FAVOR TRAIGA CON USTED EN SU VISITA)

IMPRIMIBLE DOS PAGINAS

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Arizona Ophthalmic Outpatient Surgery
300 East Osborn Road, Suite 102 ,
Phoenix, AZ 85012

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