div class=ts-pagebutton class=gotoPage data-page=1Page 1button div class=ts-imageimg data-url=addmissionproceedures-guara-ntor-name-and-address-diag-nosis-procedures-telephonehtmlpage=1 data-page=1 class=ts-thumb lazyload alt=Page 1: ADDMISSIONPROCEEDURES Guara ntor Name and Address Diag nosis Procedures Telephone: Fax: Patient No Patient Name Doctor Policy # Referring Doctor Reason Description Patient DateTime loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader030vdocumentinreader030viewer20220403105d46280b88c99391138b76dahtml5thumbnails1jpg width=140 height=200 divdiv