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2016/2017 HEALTH ASSESSMENT 13500 Lay hill Road, Silver Spring, MD 20906 Part I 3015762800 faxes: 3015762805 www.barrie.org TO BE COMPLETED BY PARENT/GUARDIAN Students Name (Last, First, Middle) Birthdate

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How to fill out 20162017 health assessment 13500

How to fill out 20162017 health assessment 13500:

01

Start by carefully reading the instructions provided with the form. This will give you a clear understanding of the information required and the sections you need to complete.

02

Provide accurate personal information such as your name, address, date of birth, and contact details. Make sure to double-check the spelling and accuracy of this information.

03

Move on to the medical history section. Answer all the questions truthfully and to the best of your knowledge. This may include providing information about any pre-existing medical conditions, allergies, or past surgeries.

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If applicable, fill out the section related to your current medications. List all the prescription drugs, over-the-counter medications, vitamins, or supplements you are currently taking. Include the dosage and frequency as requested.

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Proceed to the lifestyle section. This may require you to answer questions regarding your exercise routine, dietary habits, smoking status, alcohol consumption, and any recreational drug use. Answer honestly and give as much detail as necessary.

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If there is a section regarding family medical history, provide information about any significant diseases or conditions that run in your family. This can help healthcare professionals assess your risk factors.

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Finally, review your completed form before submitting it. Ensure that all sections are filled out accurately and completely. If you have any doubts or concerns, consider seeking assistance from a healthcare professional or someone who is familiar with the form.

Who needs 20162017 health assessment 13500:

01

Individuals purchasing health insurance: Health insurance providers may request individuals to fill out a health assessment form to better understand their overall health and assess any potential risks or pre-existing conditions.

02

Employers: Some employers require their employees to complete a health assessment form as part of their occupational health and safety protocols or to determine appropriate wellness programs or interventions.

03

Healthcare professionals: Doctors, nurses, or other healthcare professionals may require patients to fill out a health assessment form to gather necessary information for diagnosis, treatment, or preventive care.

Please note that the specific requirements for who needs to fill out the 20162017 health assessment 13500 may vary depending on the organization or situation in which the form is being used. Always refer to the specific instructions provided to determine if you need to fill out this form.

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What is 20162017 health assessment 13500?

The 20162017 health assessment 13500 is a form used to assess the health status of individuals during the years 2016 and 2017.

Who is required to file 20162017 health assessment 13500?

Individuals who received healthcare services during the years 2016 and 2017 are required to file the 20162017 health assessment 13500.

How to fill out 20162017 health assessment 13500?

To fill out the 20162017 health assessment 13500, individuals must provide information about their medical history, current health status, and any healthcare services received during the years 2016 and 2017.

What is the purpose of 20162017 health assessment 13500?

The purpose of the 20162017 health assessment 13500 is to assess the health status of individuals and identify any potential health risks or issues that may require further evaluation or treatment.

What information must be reported on 20162017 health assessment 13500?

The 20162017 health assessment 13500 requires individuals to report their medical history, current health status, and any healthcare services received during the years 2016 and 2017.

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