Get the free Thyroid Patient Information Sheet - Rolling Oaks Radiology

Facility/ Clinical: Thyroid Patient Information Sheet FORM.POL.002 Effective Date 12×6/12 Name: MR# Date: 1. What physician referred you here? EU medico LE refer AAU? 2. Why did your doctor order

How to fill out thyroid patient information sheet

How to fill out a thyroid patient information sheet:

1. Begin by providing your personal details, including your name, contact information, date of birth, and social security number if required.
2. Next, fill in your medical history, including any previous thyroid conditions you have been diagnosed with, medications you are currently taking, and any surgeries or treatments you have undergone relating to your thyroid.
3. Indicate any symptoms you are experiencing, such as weight changes, fatigue, mood swings, or difficulty swallowing, as these can provide valuable information for your healthcare provider.
4. Mention any family history of thyroid disorders, as this can provide insight into your risk factors.
5. Provide information on any allergies or sensitivities you have, including medications or substances that may affect your thyroid health.
6. Detail your current lifestyle habits, such as exercise routines, dietary preferences, and any supplements or alternative therapies you are using.
7. Express any concerns or questions you may have about your thyroid health or the information provided on the sheet.
8. Finally, sign and date the sheet to indicate that the information provided is accurate and up-to-date.

Who needs a thyroid patient information sheet?

1. Individuals who have been diagnosed with a thyroid condition or suspect they may have one.
2. Patients who are visiting a healthcare provider for thyroid-related concerns, such as an endocrinologist or primary care physician.
3. Those undergoing thyroid-related diagnostic tests or treatments.
4. Individuals participating in thyroid research studies or clinical trials.
5. Patients who are new to a healthcare practice and need to provide their medical history and relevant information regarding their thyroid health.

Note: This information is general and may vary depending on the specific requirements of the healthcare provider or institution where the thyroid patient information sheet will be used. Always follow the instructions provided by your healthcare provider when filling out any medical form.

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