Kuwana ruzivo rwekuregererwa kwemashoko ndiyo danho rokutanga pakuwana zvikwereti zvako zvekurapa zvakabhadharwa Kukundikana kutora chirwere chakarurama chechirwere, huwandu hwevanhu kana ruzivo rwehushuwarisi hunogona kutungamirira kumhosva yekuramba. Nhamba imwechete chikonzero nei zvikwereti zvizhinji zvekubhadhara zvipatara zvinorambidzwa ndezvikonzero zvekusati kuongorora inshuwarheni yekuvhara. Nokuti ruzivo rweinishuwarenzi runogona kuchinja chero nguva, kunyange kune varwere nguva dzose, zvakakosha kuti mupiki anovimbisa kukodzera kwemuteveri nguva dzose nguva dzose mazano anopiwa.
Gadzira Inscription Form Form
Iyi fomu yekunyoresa template inonyora ruzivo iyo hofisi yezvechiremba inofanira kuisanganisira pakuumba fomu yekuregesa. Sezvo iwe uchigadzira fomu yako yekunyora template, shandisa mashoko anotevera kuisa kana kukupa maonero pamusoro pezvinofanira kuiswa pane fomu yako yekunyora yakanyorwa.
Ziva Maitiro Ako Pamusoro Pekunyora Fomu
Isawo pamusoro pehuwandu hwehuwandu hwekuregeresa fomu nezvehutano hwako uye mubatsiri, uyewo zuva:
- Zita rako rekuita
- Zuva rezuva ranhasi
- Izwi reCPP
Information Patient Section of the Registration Form
Chikamu chekutanga chinofanira kusanganisira ruzivo rwemumwe murwere.
- Zita rekupedzisira, zita rokutanga nepakati pekutanga
- Nezvekuroorwa
- Social security number
- Birthdate
- Zvepabonde
- Aderesi yepanyika, mail address, city, state, uye zip code
- Kumba nhamba yefoni uye nhare yefoni
- Mushandi, basa, uye nhare yefoni yefoni
Mashoko ezvokwadi kune chikamu chemashoko ekurwara
- Chikero chetsamba yemumhepo
- Zita rekufuratira, zita rehofisi kana chipatara
- Dzimwe nhengo dzemhuri dzakaonekwa nemuitiro
- Nickname kana zita rekare
Inishuwarenzi Information Chikamu cheMagwaro ekuGadzirira
Ichi chikamu chinofanira kusanganisira mashoko einishuwarenzi kuitira kuti kunyatsokwanisa kuisa chiremba wehutano kune inshuwarisi carrier uye murwere. Yeuka kuti chikamu ichi chinofanira kuongororwa nekuvandudzwa panguva imwe neimwe yekushanyira kana nguva iyo basa rinopiwa.
- Inotarisirwa zita remutambo
- Mutoro wezuva rekuberekwa kwezuva
- Dare rekodzero yekambani
- Mutongi wenhengo foni nhamba
- Kutarisirwa kwekambani yevashandi, basa, uye nhare yefoni nhamba
- Primary inshuwarisi zita
- Mumiririri wezita
- Mubhalisi wezvokuchengetedza kwenharaunda nhamba
- Zuva rokuberekwa kwezuva
- Nhamba yechirongwa yeAbhangi
- Nhamba yeboka remubhalisi
- Ukama hwomurwere kumubhadhari
- Secondary insurance name
- Mumiririri wezita
- Mubhalisi wezvokuchengetedza kwenharaunda nhamba
- Zuva rokuberekwa kwezuva
- Nhamba yechirongwa yeAbhangi
- Nhamba yeboka remubhalisi
- Ukama hwomurwere kumubhadhari
Muchiitiko cheErgence Chikamu cheBhuku Rekunyora
Ichi chikamu chinofanira kusanganisira shamwari kana nhengo yemhuri isingararami mumusha wevarwere kuti agone kutaurirana muitiko apo murwere asingakwanisi kuonana.
- Shamwari kana zita romumhuri
- Ukama kumurwere
- Musha wefoni nhamba
- Mobile kana nhamba yefoni nhamba
Chibvumirano cheKurapa Chikamu cheBhuku Rekunyora
Chikamu chekupedzisira ndechokuwana masayina ekurapa kugamuchira kana kubvumirana kurapwa, kupiwa kwebatsiro , uye kusunungurwa kwemashoko ekugonesa.
Itai mutsara wekunyora nezuva uye zvinyorwa zvinotevera:
Mashoko aya pamusoro apa ndeechokwadi kune zvakanakisisa zvezivo yangu.
- Ndinotendera vanachiremba ((zita renyu rekuita) kuti vazvipe ini (kana kuti vanovimba) nekutarisira kwakanaka uye kwakakodzera kweutano.
- Ndinopa kambani yehutano inshuwarisi yehutano kana wechitatu mubhadhadzi wekubhadhara mari yangu yveshuwarisi zvakananga (zita renyu rekuita).
- Ndinopa (zita rako romuitiro) kuti ubudise chero ruzivo runodikanwa kuti uratidze inshuwarisi yangu kudai.
- Ndinonzwisisa kuti ini pakupedzisira ndiri mune zvemari ine mutoro kune chero sarudzo yakasara panhoroondo iyo inshuwarisi yakabhadhara kana zvikwereti zvachose kunyange kana inshuwarisi iri kumirira kana yakaramba.
Kuumba Fomu Yako Yokunyora
Iva nechokwadi chekudhinda iyo fomu neusita hwemafaira yakakura zvakakwana pakuverengwa nevanhu vanokwegura. Rega nzvimbo yakakwana pakati pemitsetse kuitira kuti vatengi vako vatone kunyora mhinduro dzacho pachena pasina kushandisa mazita akanyora. Kunyange izvi zvingaguma nepeji iyo mapeji maviri kana kupfuura, ichabatsira kuti zvose mibvunzo nemhinduro zvionekwe.