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NAME: MEDICAID ID: DOB: Informant/Relationship: AGE: GENDER: Medical Home: If child over 5 years: uncomplicated pregnancy, labor, delivery and nursery course: Y *If yes, proceed with Family and Personal
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Istory Health is a form that needs to be filled out to report certain health information.
Individuals or entities responsible for reporting health information are required to file Istory Health.
Istory Health can be filled out online or submitted physically with all required health information.
The purpose of Istory Health is to collect and report relevant health data for regulatory compliance.
Information such as patient demographics, medical history, and treatment details must be reported on Istory Health.
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