Get the free Intake age 10-17doc - portlandnaturalmedicine

Portland Natural Medicine 516 SE Morrison St., Ste.207, Portland, OR 97214 pH: (503× 2391022 Fax: (503× 5125850 PATIENT PREFERRED CONTACT FORM Name Last First M.I. Date of Birth Address Street City

How to fill out intake age 10-17doc

How to fill out intake age 10-17doc:

1. Begin by carefully reading the instructions provided on the intake age 10-17doc form. This will give you an understanding of the information needed and the sections that require completion.
2. Begin with the personal details section, where you will be asked to provide the child's name, age, date of birth, and contact information. Ensure that all the information is accurate and up-to-date.
3. Move on to the medical history section, where you will need to provide information about any pre-existing medical conditions, allergies, medications, or previous surgeries the child may have had. If you are unaware of any specific details, it is advisable to consult with the child's parent or guardian for accurate information.
4. Next, complete the emergency contact section. Include the names, relationship, phone numbers, and addresses of at least two individuals who can be contacted in case of an emergency.
5. If there are specific consent forms or waivers attached to the intake age 10-17doc, make sure to review them carefully and provide your signature where necessary. These forms might include consent for medical treatment, participation in activities, or sharing of information with other professionals involved in the child's care.
6. Finally, review all the information provided on the form to ensure its accuracy. Double-check the spelling of names, dates of birth, and contact information. Once you are satisfied with the completed form, sign and date it in the designated area.

Who needs intake age 10-17doc:

1. Parents or guardians of children aged 10-17 who are seeking medical or professional services for their child.
2. Healthcare providers, schools, or organizations that require comprehensive information about a child's background and medical history in order to provide appropriate care or services.
3. Institutions that work with children and require parental consent for activities, trips, or programs for children aged 10-17.
4. Researchers or professionals collecting data about children aged 10-17 for the purposes of study or analysis.

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