Patient Access Verification Card

THC M.D. Inc.
	Patient Verification

To verify patient has a current recommendation, enter patient name, date of birth and expiration date as shown on the letter of recommendation
or patient access verification card.


	Patient Name: First Last Date of Birth: Expiration Date:	(Month, Day, Year)

This tool is provided as an additional method of verifying that the patient has a current valid recommendation. It should only be used in conjunction with a letter of recommendation and accompanied by proper photo identification of patient.

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