Get the free I-131 OUTpatient Questionnaire - Sunnybrook Hospital

Appendix A: I131 Outpatient Questionnaire PATIENT NAME: MAN: DOB: PATIENT TEL: (H ...

How to fill out i-131 outpatient questionnaire

How to fill out i-131 outpatient questionnaire:

1. Start by carefully reading the instructions provided with the form. The instructions will guide you through each section of the questionnaire.
2. Provide your personal information in the designated fields. This includes your name, address, date of birth, and contact information.
3. Indicate the purpose of your travel by selecting the appropriate option. You may need to provide additional details or documentation depending on the purpose of your travel.
4. Answer the medical history questions honestly and accurately. If you have any pre-existing conditions or medical concerns, make sure to provide all the necessary information.
5. If you have traveled to certain countries or regions within the past year, indicate them in the relevant section. This is important for public health and safety reasons.
6. Review the completed form to ensure all the required fields are filled and the provided information is correct. Make any necessary corrections or additions before submitting the form.
7. Sign and date the form to certify the accuracy of the information provided.
8. Keep a copy of the completed form for your records before submitting it.

Who needs i-131 outpatient questionnaire:

1. Individuals who are planning to travel outside the United States and need to apply for an advance parole document.
2. Individuals who have recently traveled outside the United States on a temporary basis and are returning as a parolee.
3. Individuals applying for re-entry after traveling to certain countries or regions that might pose public health risks.

It is important to note that this answer provides a general overview of filling out the i-131 outpatient questionnaire. Specific instructions and requirements may vary, so it is advisable to refer to the official USCIS website or consult an immigration attorney for accurate and up-to-date information.

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What is i-131 outpatient questionnaire?

The i-131 outpatient questionnaire is a form that patients need to fill out before undergoing outpatient treatment using i-131, a radioactive isotope.

Who is required to file i-131 outpatient questionnaire?

Patients who are scheduled to undergo outpatient treatment using i-131 are required to file the i-131 outpatient questionnaire.

How to fill out i-131 outpatient questionnaire?

Patients can fill out the i-131 outpatient questionnaire by providing accurate information about their medical history, current health status, and any medications they are taking.

What is the purpose of i-131 outpatient questionnaire?

The purpose of the i-131 outpatient questionnaire is to ensure the safety of patients undergoing treatment with i-131 and to help healthcare providers customize treatment plans.

What information must be reported on i-131 outpatient questionnaire?

Patients must report their medical history, current health status, any medications they are taking, any allergies they have, and any previous exposure to radioactive materials on the i-131 outpatient questionnaire.