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Health Status Survey Patient Name: File #: Date: Please X the box for any conditions or symptoms presently causing you problems. Please check mark the box for those conditions or symptoms that you
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How to fill out Duffins Health Status Survey:

01
Start by accessing the Duffins Health Status Survey online or obtaining a hard copy from a healthcare provider or organization.
02
Read through the instructions and questions carefully to understand the purpose and requirements of the survey.
03
Provide accurate and honest responses to each question, ensuring that your answers reflect your true health status and experiences.
04
If a question seems unclear or you are unsure about how to answer, seek clarification or assistance from a healthcare professional.
05
Take your time to consider each question and provide well-thought-out responses. Avoid rushing through the survey.
06
Ensure that you have all necessary information readily available, such as your medical history, current medications, and relevant health records, as you may need to reference them while completing the survey.
07
Double-check your responses before submitting the survey to ensure accuracy and completeness.
08
If the survey allows for additional comments or explanations, utilize this opportunity to provide further context or details that may be relevant to your health status.
09
Once you have completed the survey, follow the instructions provided to submit it as required.

Who needs Duffins Health Status Survey:

01
Individuals who are seeking healthcare services from a specific provider or organization may be required to fill out the Duffins Health Status Survey as part of the intake process.
02
Patients who are undergoing a medical procedure or treatment plan that necessitates understanding their overall health status and medical history may be requested to complete the survey.
03
Researchers or healthcare professionals conducting studies or analyzing health data may administer the Duffins Health Status Survey to gather information and assess the health status of specific populations or individuals.
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