AUTHORIZATION FOR RELEASE OF INFORMATION
Apr 01, 2019 · send completed form to: ROI-requestor3@dm.duke.edu; Fax: 919-620-5165 OR Duke University Hospital - HIM P.O. Box 3016 Durham, NC …
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VERBAL RELEASE OF INFORMATION AUTHORIZATION
www.dukehealth.orgSEND COMPLETED FORM TO: ROI-requestor3@dm.duke.edu; Fax: 919-620-5165 OR Duke University Hospital - HIM P.O. Box 3016 Durham, NC 27710; For Questions Call: 919-684-1700
Financial Assistance Application Patient/Guarantor Information
www.dukehealth.orgFinancial Assistance Application Patient/Guarantor Information Patient’s Name: ... Patient’s MRN/Guar ID: Clearly print the medical record number Duke Health has issued the patient or ... under our financial assistance policy. If you do not have, or cannot produce the items listed, please include an explanation as to why. Comments . 4
COLONOSCOPY PREPARATION INSTRUCTIONS WITH …
www.dukehealth.orgCOLONOSCOPY PREPARATION INSTRUCTIONS WITH GOLYTELY ONE DAY PREPARATION IMPORTANT: Please read these instructions TWO WEEKS before your colonoscopy so you are well prepared. If you have diabetes, call your doctor to discuss blood sugar medicines. You have been scheduled for a Colonoscopy with Duke Gastroenterology …
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Duke University Hospital Map Guide
www.dukehealth.orgin mind. If you have a question or need help finding your way around the hospital, we hope you will not ... Maps & Directories 3 Duke University Hospital, Level 1 3 (fold-out map) Duke Hospital ... Please ask a member of the staff before using your cell phone, as cell phone use may not be allowed in some areas.
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WEEK 2 January 10, ,2022 MONDAY
www.dukehealth.orgturkey meatball stroganoff 200 14 15 11 4 1 2 herb roasted pork loin 190 <1 27 7 2.5 sodium (mg) 460 160 0 0 sides seasoned spinach 70 5 5 4.5 1.5 180 4 <1 roasted root vegetables 90 18 3 1.5 0 320 5 7 steamed mixed vegetables 20 3 1 0 0 30 1 2 italian roast potatoes 100 20 2 1.5 0 105 2 1
WEEK 1 January 24, 2022 MONDAY
www.dukehealth.org610 110 <1 9 sides steamed mixed vegetables 20 3 1 0 0 30 1 2 asparagus amandine 40 2 2 3 1 65 1 <1 seasoned steamed peas 80 12 5 2.5 1.5 140 4 4
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www.wcb.ny.govThe undersigned requests written authorization for the following special service(s) costing over $1,000 or requiring pre-authorization pursuant to the Medical Treatment Guidelines.Do NOT use this form for injuries/illnesses involving the Mid and Low Back, Neck, Knee, Shoulder, Carpal Tunnel Syndrome and Non-Acute Pain, except for the treatment/procedures listed below under