Pleasantdaleambulatorycare.org

Pre-Admission Form

WEBDo you have, or have you been advised to schedule, any upcoming medical tests, e.g., x-ray, stress test? If yes, please provide details.

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URL: https://pleasantdaleambulatorycare.org/pre-surgery/pre-admission-form/

PLEASANTDALE AMBULATORY CARE Your Rights and …

WEBSurprise Medical Bills Summary of New Jersey State Law Out-of-network Balance Billing Protection: Under New Jersey law, health care providers are prohibited from balance …

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Valid Photo ID (driver’s license, U.S. passport, hospital ID, etc.)

WEB1 61 D Main Street • West Orange • NJ 07052 • Tel: (973) 324-2280 • Fax: (973) 324-2285 Dear Physician: Thank you for your interest in joining the staff at the Pleasantdale …

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PLEASANTDALE AMBULATORY CARE NOTICE OF PATIENT …

WEBPLEASANTDALE AMBULATORY CARE NOTICE OF PATIENT PRIVACY Page 1 of 2 This notice describes how medical information about you may be used and disclosed and …

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