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Pediatric Health History Please complete both sides of form Name: DOB: Mother s name: DOB: Father s name: DOB: Guardian s name: DOB: How many siblings live with the patient? Mother s occupation: Father

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What is pediatric health history?

Pediatric health history is a record of a child's medical background, including past illnesses, medications, surgeries, and family medical history.

Who is required to file pediatric health history?

Parents or guardians of the child are typically required to file pediatric health history forms.

How to fill out pediatric health history?

Pediatric health history forms can be filled out by providing accurate and detailed information about the child's medical background and family history.

What is the purpose of pediatric health history?

The purpose of pediatric health history is to provide healthcare providers with important information about a child's health to aid in diagnosis and treatment.

What information must be reported on pediatric health history?

Information such as past illnesses, medications, surgeries, allergies, family medical history, and any current health concerns must be reported on pediatric health history forms.

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