| Document Date: 2015-01-30 19:20:00
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City Lupus / / Company BT / Vision Insurance Company / Medical Insurance Company / EPO / / IndustryTerm secondary/supplemental insurance / Insurance coverage / insurance claims / Non-contracted insurance / insurance carriers / health insurance carriers / insurance / insurance benefits / claim/services / care and services / co-insurance / insurance claim / insurance carrier / / MedicalCondition Glaucoma / Double Vision / Paralysis / certain eye diseases / allergies / TB / Headaches / Cancer / Chronic/Frequent Cough Yes No Yes No Arthritis / HIV / Chest Pain / Cataracts / Heart Disease DILATION / Seizures / Arthritis / Ears Yes No Yes No High Cholesterol / Macular Degeneration / Stroke / Lazy Eye / Diabetes / High Blood Pressure Macular Degeneration Diabetes / Joint Pains Yes No Yes No Allergies / Neurological Diseases / High Blood Pressure / illness / MS / Depression / Anemia / cataract / Blindness / Head Injury / / MedicalTreatment surgery / cataract surgery / / Organization MEDICARE / / Person Injury / / Position attorney / Physician / Date COMPREHENSIVE HISTORY FORM GENERAL / Head / / Product Ipad / DV / / ProvinceOrState Mississippi / / Technology laser / CAT / /
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Abba Eye Care PATIENT REGISTRATION Welcome to our office. We are committed to providing the best and most comprehensive care possible. We encourage you to ask questions. In order to bill your insurance carrier, we need c