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UNDERSTANDING YOUR STATEMENT

WebWhich is why we’ve designed our billing statement based on patient feedback to ensure they are easy to read and understand. APD{152973985} Please contact our Customer …

Actived: 8 days ago

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Your care is personal. Let’s keep it that way.

WebBY PHONE. 630-545-7600. DUPAGE MEDICAL GROUP, LTD. //NOTICE OF PRIVACY PRACTICES 1. Your care is personal. Let’s keep it that way. Get an electronic or paper …

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Class 3: Putting It All Together With Diabetes

WebBreakfast: 2 pieces of whole wheat toast with butter, 2 eggs, small orange, coffee with 1% milk Lunch: Turkey sandwich on rye bread, 1 cup of tomato soup, 1 cup of 1% milk …

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Planning healthy meals

Web6 Protein Fat Lean meat 7 g 0–3 g Medium-fat meat 7 g 4–7 g High-fat meat 7 g 8+ g • Do not raise blood glucose significantly • Use sparingly and limit saturated fat • Will help …

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Do Not Bill Insurance (Patient Requested Restriction)

WebADM004 Page 1 of 1 Patient Label MRN: Pt Name: Date of Birth: Do Not Bill Insurance (Patient Requested Restriction) You have the right to request restrictions as to how your …

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Safe Options for Home Needle isposal

WebFrequently Asked Questions. What does “Medical Sharps” mean? Medical Sharps (syringes, hypodermic needles, needles attached to tubing, lancets, etc.) are considered biohazardous

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PREFERRED DIALYSIS CENTERS

WebPREFERRED DIALYSIS CENTERS DuPage Medical Group (DMG) is committed to providing you with the support and resources needed throughout your care.

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HEALTH AND NUTRITION QUESTIONNAIRE

WebHeart Problems . Circulation Problems . Food Allergies / Intolerances . High Cholesterol . Breathing Problems . Celiac Disease . High Blood Pressure . Sleep Apnea

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Good Faith Estimates

WebGood Faith Estimates . You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give

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MediCopy Authorization for the Release of Medical Records

WebMediCopy Authorization for the Release of Medical Records Send to: MediCopy Services, Inc. 8 City Blvd., Ste 400 Nashville, TN 37209 • P: 615-780-2741 F: 833-606-1226 • …

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Learn more about virtually scarless surgery using Single-Site

WebThe Enabling Technology: da Vinci® Surgical System with Single-Site ® Technology The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, …

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MEDICARE ANNUAL WELLNESS VISIT

Webwww.southbendclinic.com Granger Family Med. 52500 Fir Road Granger, IN 46530 574-271-0700 Ironwood Rd. 2102 E. Inwood South Bend, IN 46614 574-299-2400

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PRE-SURGICAL CHECKLIST

WebDuPageMedicalGroup.com PRE-SURGICAL CHECKLIST Bariatric Surgery The decision to proceed with bariatric surgery is a personal one and may be recommended for you if you …

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AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION …

WebScanSTAT Technologies 1100 W. 31st St. Downers Grove, IL 60515 Phone: 630-873-8748 Fax: 630-873-8797 [email protected] DMG-ADM010 Page 1 of 1 . …

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Pre PET/CT Diet Plan & Meal Ideas (Low Carb Diet)

Web4. If your PET is scheduled after 10:00am: a. Eat a low carbohydrate breakfast at least 4 hours prior to your appointment. b. Inject ½ dose of short acting insulin or take your …

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TEEN PROXY FORM teen’s

WebTEEN PROXY FORM. Please complete the following information for access to a teen’s (12-17) MyChart account at Duly Health and Care (Duly). Proxy access for minors under 17 …

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Rheumatology Health History Questionnaire

WebPAST MEDICATIONS: Please review this list of “arthritis” medications. As accurately as possible, try to remember which medications you have taken, how long you were taking …

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ADULT PROXY FORM

WebPlease note: the patient’s information will be accessed through the designated proxy’s own MyChart account, and both the designated proxy and the patient must sign …

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Workers’ Compensation Form

WebWorkers’ Compensation Form DMG Staff Instructions: Email completed form to Registration (rq-regqueue) and send the original form to the Workers

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CHILD PROXY FORM

WebDMG-ADM006 Page 1 of 1 . CHILD PROXY FORM . Please complete the following information for access to a minor’s MyChart account at Duly Health and Care …

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