Pre-Admission Form

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PATIENT INFORMATION

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Admission Type: Maternity
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Single Married Widowed Divorced

EMERGENCY CONTACT


ADVANCED DIRECTIVES: PLEASE SELECT THE CORRECT RESPONSE

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INSURANCE INFORMATION

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Hamilton Diagnostics Center
1407 N Thornton Avenue
Dalton, Georgia 30720
706-272-6565 Appointment
706-272-6549 All other inquires
706-272-6567 FAX
Turner Maternal & Infant Care Center
1101 Burleyson Road (across from Professional Pharmacy)
Dalton, Georgia 30720
706-272-6441 Admissions

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