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BUG NJ×b HEALTH HISTORY QUESTIONNAIRE Name: DOB: Height: Weight: Referring Physician: Primary Physician: Pharmacy: Pharmacy Town×Phone: Hospital Used:
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How to fill out ugnj health history questionnaire
Who needs to fill out the UGNJ health history questionnaire?
01
Patients visiting the UGNJ facility for the first time.
02
Patients who have not filled out the questionnaire in the past year or whose medical history has changed significantly.
How to fill out the UGNJ health history questionnaire:
01
Start by carefully reading the instructions provided with the questionnaire.
02
Provide accurate personal information such as your name, date of birth, and contact details.
03
Answer all the questions related to your medical history. This includes any previous illnesses, surgeries, or hospitalizations you have had.
04
Be thorough in providing information about your current medications, including any over-the-counter drugs or supplements.
05
If applicable, mention any allergies or adverse reactions to medications.
06
Fill in the sections regarding your family medical history, including any hereditary conditions or diseases that may run in your family.
07
If you are unsure about any question, do not hesitate to ask for clarification from the UGNJ staff.
08
Review the completed questionnaire to ensure all the sections have been filled out accurately and completely.
09
Sign and date the questionnaire as required.
10
Submit the filled-out questionnaire to the UGNJ facility either by mail or in person before your appointment.
11
Keep a copy of the questionnaire for your records.
12
Please note that the information provided in the UGNJ health history questionnaire will be treated as confidential and will assist the healthcare professionals in providing you with appropriate care.
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What is ugnj health history questionnaire?
The Ugnj health history questionnaire is a form used to collect information about an individual's medical history.
Who is required to file ugnj health history questionnaire?
All individuals are required to file the Ugnj health history questionnaire.
How to fill out ugnj health history questionnaire?
To fill out the Ugnj health history questionnaire, individuals must provide detailed information about their medical history.
What is the purpose of ugnj health history questionnaire?
The purpose of the Ugnj health history questionnaire is to gather important information about an individual's health background.
What information must be reported on ugnj health history questionnaire?
Information such as past illnesses, surgeries, medications, and family medical history must be reported on the Ugnj health history questionnaire.
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