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DEPARTMENT OF CHILDREN AND FAMILIES Division of Early Care and Education DCF (CFS2345) (R. 03/2009) STATE OF WISCONSIN Page 1 of 2 HEALTH HISTORY AND EMERGENCY CARE PLAN Use of form: This form is
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How to fill out health history and emergency:

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Start by gathering all necessary information: Begin by collecting important personal details such as full name, date of birth, contact information, and any relevant identification numbers.
02
Provide details about your medical history: Fill out sections regarding any past or current medical conditions, surgeries, or injuries. Include information about any chronic illnesses, allergies, or medications you are currently taking.
03
Mention any known family medical history: If there are any hereditary conditions or diseases that run in your family, it is crucial to mention them. This information can be helpful for medical professionals to identify potential risks or concerns.
04
Describe previous hospitalizations and emergency medical treatment: In this section, provide details about any previous hospitalizations, emergency room visits, or medical procedures you have undergone. Include dates, reasons for admission, and any important outcomes.
05
List current contact information for emergency purposes: This section is essential to fill out accurately. Include the name, phone number, and relationship of your emergency contact person. Also, provide information about alternative contacts if necessary.
06
Explain any specific medical conditions or requirements: If you have any unique medical conditions or specialized healthcare needs, be sure to mention them. This information will alert medical professionals about any specific care you may require in an emergency situation.

Who needs health history and emergency?

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Individuals seeking medical care: Anyone visiting a new healthcare provider or facility should be prepared to fill out a health history and emergency form. This process ensures that the medical professionals have all the necessary information to provide appropriate care and make informed decisions.
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Patients with chronic conditions: Individuals with chronic illnesses or ongoing medical conditions often visit healthcare providers regularly. Filling out a health history and emergency form enables doctors to have a comprehensive understanding of the patient's medical background and better manage their condition.
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Individuals participating in high-risk activities: It is particularly important for individuals participating in high-risk activities such as extreme sports or adventurous pursuits to have a health history and emergency form on hand. In case of an accident or medical emergency, this information can aid medical professionals in delivering the appropriate care quickly.
In conclusion, everyone seeking medical care or with an ongoing medical condition should fill out a health history and emergency form. Additionally, individuals involved in high-risk activities should also have this information readily available.
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Health history and emergency is a document that contains important medical information and contact details in case of an emergency.
All individuals are required to file health history and emergency.
Health history and emergency can be filled out by providing accurate and up-to-date medical information and emergency contact details.
The purpose of health history and emergency is to ensure that essential medical information is readily available in case of an emergency.
Information such as medical conditions, allergies, medications, and emergency contact details must be reported on health history and emergency.
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