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PITTSBURGH PULMONARY ASSOCIATES NEW PATIENT QUESTIONNAIRE Name: Date: DOB: Age: Height: Weight: Referred by: PCP Medication Allergies: Reaction: Date of last flu vaccine: Last Pneumonia: Positive

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How to fill out pittsburgh pulmonary associates new

How to fill out Pittsburgh Pulmonary Associates New:

01

Start by obtaining the necessary paperwork from Pittsburgh Pulmonary Associates or their website. This may include a new patient form or medical history questionnaire.

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Fill out your personal information accurately and completely. This may include your name, date of birth, address, phone number, and email address.

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Provide your medical history, including any previous diagnoses, medications, allergies, and surgeries. Be sure to include dates and relevant details.

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If you have any specific concerns or reasons for seeking care at Pittsburgh Pulmonary Associates, make sure to clearly explain them in the appropriate section of the form.

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Sign and date the form at the designated area to authorize the release of your medical information to Pittsburgh Pulmonary Associates.

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Who needs Pittsburgh Pulmonary Associates New:

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Individuals experiencing respiratory problems or conditions such as asthma, chronic obstructive pulmonary disease (COPD), lung cancer, or sleep apnea may require the specialized care provided by Pittsburgh Pulmonary Associates.

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Patients seeking second opinions or seeking further treatment options for their respiratory conditions may also benefit from consulting with the physicians at Pittsburgh Pulmonary Associates.

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Pittsburgh Pulmonary Associates may also accept referrals from primary care physicians or other healthcare providers who believe their patients would benefit from the expertise and services offered by the practice.

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