Medicare Sign Up pack sample

Nurse / Enfermera: ____________________________________ ______ __ Aide / Auxiliar Enfermera: _________________________________ _____ T herapist / Terapista: ____________________________________ ______ Physician / Doctor: ______________________________________ ______ Director of Nursing, Clinical Manager / Director de Enfermería, Gerente Clínico: Ar Camacho, RN Administrator / Administrador: RAUL CAMACHO 2950 W 84 St. Bay 7. Hialeah, FL 33018 www.pnsystem.com Ph: (305) 818‐5940 Fax: (305) 818‐5935 info@pnsystem.com Admission Package Formas De Admisión Client InformaƟon Handbook Manual De Información Al Paciente www.pnsystem.com License #: HHA2115?????—Medicare/Medicaid CerƟfied Home Health Agency Please Verify Patient’s Identity prior to providing care/services PN SYSTEM (Your Company Info/Logo Here) Totally CUSTOMIZABLE! sample

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