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Lisa B. David, M.D. Britton B. Eldridge, M.D. EVALUATION FOR DIZZINESS Patient: DOB: DATE: I. When you are dizzy, do you experience any of the following sensations? Please read the entire list first,
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How to fill out evaluation for dizziness

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How to fill out evaluation for dizziness:

01
Begin by gathering information about the dizziness episode. Note the frequency, duration, and triggers of the episodes.
02
Describe the type of dizziness experienced. Is it a spinning sensation (vertigo), a feeling of lightheadedness, or a sense of unsteadiness?
03
Document any accompanying symptoms, such as nausea, vomiting, hearing loss, or headaches.
04
Mention any medications or treatments that have been tried for the dizziness and their effectiveness.
05
Note any medical conditions or history that may be relevant to the dizziness, such as ear infections, head trauma, or cardiovascular problems.
06
Include any lifestyle factors that may contribute to the dizziness, such as excessive alcohol consumption, lack of sleep, or high stress levels.
07
Provide a thorough medical history, including any pre-existing conditions or medications being taken.
08
Detail any recent changes in medications, dosage, or lifestyle.
09
Finally, be sure to provide accurate contact information for yourself and any healthcare providers involved in your care.

Who needs evaluation for dizziness:

01
Individuals who experience recurring or persistent episodes of dizziness should seek evaluation. This includes those who frequently feel lightheaded, experience vertigo, or have an unsteady gait.
02
People who have recently suffered from head trauma or injuries that may affect the inner ear or balance system should also seek evaluation.
03
Individuals with a history of cardiovascular problems, such as high blood pressure or irregular heartbeat, may require evaluation for dizziness.
04
Older adults who experience dizziness, especially when it impacts their daily activities or increases the risk of falls, should be evaluated.
05
Anyone who experiences sudden and severe dizziness, accompanied by other concerning symptoms such as chest pain or difficulty breathing, should seek immediate medical evaluation.
Remember, it is important to consult a healthcare professional for a comprehensive evaluation and diagnosis of dizziness. The information provided here is for informational purposes only and should not replace medical advice.
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Evaluation for dizziness is a medical assessment used to determine the cause and severity of dizziness experienced by an individual.
Individuals experiencing dizziness symptoms may be required to undergo evaluation for dizziness by a medical professional.
Evaluation for dizziness should be filled out by a qualified medical professional who will conduct a physical examination, review medical history, and perform diagnostic tests.
The purpose of evaluation for dizziness is to diagnose the underlying condition causing dizziness and develop an appropriate treatment plan.
Information reported on evaluation for dizziness may include symptoms experienced, medical history, medications taken, and results of diagnostic tests.
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