Family Doctor definition

Family Doctor. Name: Address: Phone: Are your child’s immunisation records up to date? ◼ Yes ◼ No (please provide a copy for file) If my child is unwell I will arrange for my child to be collected from the centre, within an hour of being contacted. I understand that my child cannot attend the centre if they are sick/infectious.
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Family Doctor. Doctor’s Phone: Medical Concerns to be Shared with Coaches: NOTE: ALL STUDENTS TRYING OUT/PRACTICING FOR A SPORT MUST HAVE A CURRENT PHYSICAL EXAM ON FILE WITH THE SCHOOL NURSE. A CURRENT PHYSICAL EXAM IS ONE THAT HAS BEEN COMPLETED WITHIN TWELVE MONTHS OF THE LAST DAY OF THE SEASON. PHYSICALS ARE VALID FOR ONE CALENDAR YEAR. o o Is your student covered under a school insurance policy? Yes No If not, your signature constitutes a waiver and a confirmation of other insurance coverage: Insurance Company: Policy Number:
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Family Doctor. Last Name: First Name: Address: Phone: City: State: Zip Code:
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Examples of Family Doctor in a sentence

  • X Patient Name Signature DatePATIENT INFORMATION Last Name: First Name: SEX: M F If patient is a minor, name of parent or guardian accompanying patient: Relationship to patient: Phone # (if different): Address: City: State: Zip Code: Home Phone: 2nd Phone: Email: Date of Birth: SS#: married single divorced widowed (circle one)Referred by: Phone: Location: Family Doctor: Phone: Location: INSURANCEDate of accident:(If applicable): Type of Accident: Please briefly describe the accident.

  • Patient Name Patient Signature Date Patient Information Last Name: First Name: Sex: M FIf patient is a minor, name of parent or guardian accompanying patient: Relationship to Patient: Phone # (if different): Address: City: State: Zip Code: Home Phone: 2nd Phone: Email: Date of Birth: SS# Married Single Divorced WidowedReferred by: Phone: Location: Family Doctor: Phone: Location: INSURANCE Date of Accident (if applicable): Type of Accident: Please briefly describe the accident.

  • YES/NOIf YES, please provide details below and attach supporting medical documentation……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Staff member signature for sighted: Family Doctor: ......................................................................................

  • I understand the extent and limitations of the insurance cover provided.Contact InformationAddress: Home Telephone No. Work Telephone No. Emergency contact address if different from that aboveAddress: Tel No. Name of Family Doctor: Telephone Nos.

  • The Clinic will work in good faith with the RHA’s Primary Care Connector to accept patients who have requested a primary care provider through the provincial Family Doctor Connection Program.

  • Patient/Guardian email address is: Employer: Employer Address: Family Doctor (Full Name): Referring Doctor (Full Name): Pharmacy: Address: Phone: Please list an alternate person to whom we may release medical information if you are unable to be reached.

  • Emergency Contact Phone Number ( ) Medical Insurance Policy Number Member’s Name Phone Number ( ) Family Doctor Phone Number ( ) In the event of an emergency, the undersigned hereby give(s) permission to be transported to a hospital.

  • Patient Name Patient Signature Date Patient InformationLast Name: First Name: Sex: M F If patient is a minor, name of parent or guardian accompanying patient: Relationship to Patient: Phone # (if different): Address: City: State: Zip Code: Home Phone: 2nd Phone: Email: Date of Birth: SS# Married Single Divorced Widowed Referred by: Phone: Location: Family Doctor: Phone: Location: INSURANCEDate of Accident (if applicable): Type of Accident: Please briefly describe the accident.

  • Family Doctor Phone Insurance Carrier ID Family Dentist Phone Insurance Carrier ID My child has ALLERGIC REACTIONS to the following medication(s) CONSENT FOR MEDICAL TREATMENTCITY OF ROSEVILLE, AUTHORIZATION BY PARENT OR GUARDIAN TO ADULT PERSON TO CONSENT TO MEDICAL, SURGICAL, HOSPITAL, AND DENTAL CARE TOMINOR.

  • NAME COMPLETE ADDRESSOr Telephone Number Pediatrician (PCP) Family Doctor Occupational Therapist Speech Pathologist Physical Therapist Psychologist Psychiatrist Counselor Others (please specify) ***Please use the backside of this page for providing any other information you feel will be helpful.


More Definitions of Family Doctor

Family Doctor. Phone: Hospital: Known Allergies: Alternate Emergency Contact Name(s): Relationship: Phone(s): OR SPECIAL EDUCATION NEEDS DISCLOSURE (Required at time of registration): ** If student is served at their school as a Special Ed student, the most current IEP must be filed in the DTC Office prior to course start date in order for student to be served. Please, Do Not withhold this information, as it means the success and safety of your child.
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Family Doctor means being registered and in good standing with the College of Physicians and Surgeons of Ontario to conduct a practice in Family Medicine;
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Related to Family Doctor

  • Family day home means a child day program offered in the residence of the provider or the home of any of the children in care for one through 12 children under the age of 13, exclusive of the provider's own children and any children who reside in the home, when at least one child receives care for compensation. The provider of a licensed or registered family day home shall disclose to the parents or guardians of children in their care the percentage of time per week that persons other than the provider will care for the children. Family day homes serving five through 12 children, exclusive of the provider's own children and any children who reside in the home, shall be licensed. However, no family day home shall care for more than four children under the age of two, including the provider's own children and any children who reside in the home, unless the family day home is licensed or voluntarily registered. However, a family day home where the children in care are all related to the provider by blood or marriage shall not be required to be licensed.

  • Family leave means a leave of absence from employment for one (1) of the following reasons: (1) The serious illness of an eligible employee; or (2) the serious illness of a member of an eligible employee’s immediate family. Family Leave, by itself or in combination with statutory Parental Leave (as opposed to contractual parental leave), may not exceed twelve (12) weeks in a twelve (12) month period beginning with the first day either type of leave is used. Leave taken under this Agreement will be credited against any such statutory entitlement to the full extent permitted by law.

  • Family or “family member” means your spouse, and any child, stepchild, parent, or parent-in-law who receives more than one-half of his or her support from you or from whom you receive more than one-half of your support.

  • Participating Marriage and Family Therapist means a Marriage and Family Therapist who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Non-Participating Marriage and Family Therapist means a Marriage and Family Therapist who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Doctor means a licensed health care provider acting within the scope of his or her license and rendering care or treatment to a Covered Person that is appropriate for the conditions and locality. It will not include a Covered Person or a member of the Covered Person’s Immediate Family or household.