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Patientinformationrecord1 REVISED 061113.pdf 1 6/11/2013 4:15:53 PM PATIENT INFORMATION RECORD (Please Print or Write Legibly) TO OUR PATIENTS: All gray box text must be completed to meet the requirements

How to fill out patient-information-record1 revised 061113

How to fill out patient-information-record1 revised 061113:

1. Start by writing the patient's full name, date of birth, and contact information. Make sure to include accurate and up-to-date details.
2. Next, provide the patient's medical history, including any previous illnesses, chronic conditions, or surgeries they have undergone. It's essential to be thorough and include all relevant information.
3. Fill in the section for current medications, including the name, dosage, and frequency of each medication the patient is currently taking. This helps healthcare providers assess any potential drug interactions or side effects.
4. Include information about the patient's allergies, especially any known drug allergies or allergies to specific substances. This information is crucial to ensure patient safety during medical treatments.
5. Provide the patient's emergency contact details, including the name, relationship, and phone number of someone who can be reached in case of an emergency. It's essential to have a reliable emergency contact for prompt communication.
6. Lastly, sign the form to confirm that all the information provided is accurate and complete. This signature serves as consent for the healthcare providers to use the information for the patient's medical care.

Who needs patient-information-record1 revised 061113:

1. Healthcare providers: Doctors, nurses, and other healthcare professionals require the patient-information-record1 revised 061113 to have a comprehensive understanding of the patient's medical history, current medications, allergies, and emergency contacts. This information assists in providing appropriate and personalized medical treatment.
2. Patients: The patient-information-record1 revised 061113 is beneficial for patients themselves as it acts as a summary of their medical information. It helps patients keep track of their medical history and ensures that they receive proper care, especially when seeing different healthcare providers or during emergencies.
3. Administrative staff: Medical office staff, such as receptionists or medical record keepers, may also need to access patient-information-record1 revised 061113. This document assists in managing appointments, billing, and maintaining accurate patient records.

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