Get the free WISEWOMAN Screening Form - Michigan Cancer - michigancancer
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WISEMAN Screening Form Screening Date LCA Name Screening Site Last Name First Name Clinical Measurement Result MBCS ID Middle Initial Birth Date Categories and Protocols for Medical Referral BMI Obesity:
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How to fill out wisewoman screening form
How to fill out the Wisewoman screening form:
01
Start by gathering the necessary information such as your personal details, contact information, and basic medical history.
02
Begin filling out the form by entering your name, address, phone number, and email address in the appropriate fields.
03
Proceed to provide information about your age, height, weight, and any existing medical conditions you may have.
04
Answer the questions related to lifestyle choices such as smoking habits, alcohol consumption, and physical activity level.
05
Next, you may be asked about your family medical history, including any instances of heart disease, stroke, or high blood pressure among close relatives.
06
The form may also include questions regarding your nutrition habits, such as the types of foods you typically consume and any dietary restrictions you may have.
07
You may be asked about your knowledge of cardiovascular disease risk factors and whether you have received any previous screenings or tests related to heart health.
08
Lastly, review your responses to ensure accuracy and completeness before submitting the form.
Who needs the Wisewoman screening form?
01
Women who are concerned about their cardiovascular health and would like to assess their risk of developing heart disease or related conditions may need the Wisewoman screening form.
02
Those who have a family history of heart disease or other risk factors may benefit from filling out the form to identify potential risks and take appropriate preventive measures.
03
Women who are looking to improve their overall health and well-being by understanding their predisposition for heart-related issues could consider filling out the Wisewoman screening form.
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What is wisewoman screening form?
The wisewoman screening form is a questionnaire designed to assess a woman's risk for heart disease and stroke.
Who is required to file wisewoman screening form?
Women who are eligible for the WIseWoman program are required to file the screening form.
How to fill out wisewoman screening form?
The wisewoman screening form can be filled out online or in person at a WIseWoman program site with the help of a healthcare provider.
What is the purpose of wisewoman screening form?
The purpose of the wisewoman screening form is to identify women at risk for heart disease and stroke and provide them with appropriate interventions.
What information must be reported on wisewoman screening form?
The wisewoman screening form requires information about medical history, lifestyle habits, and family history of heart disease or stroke.
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