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HEALTH HISTORY FAME L Y DE DENTISTRY Serving St. Johns and the Greater Portland Area For Over 30 years PLEASE PRINT THE FOLLOWING INFORMATION. THIS INFORMATION IS IMPORTANT FOR OUR RECORDS AND YOUR
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How to fill out health history fami l

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Point 1: Start by gathering necessary information
01
Identify the family members who need to be included in the health history fami l.
02
Collect their personal details such as full name, date of birth, and contact information.
Point 2: Record medical conditions and illnesses
01
Inquire about any chronic or genetic diseases that run in the family.
02
Note down specific details regarding each family member, including the type of condition, age of diagnosis, and treatment methods.
Point 3: Document any allergies or sensitivities
01
Ask about any known allergies or sensitivities within the family.
02
Include information about the type of allergen and the symptoms experienced.
Point 4: Include information on surgeries or procedures
01
Inquire about any major surgeries or medical procedures family members have undergone.
02
Take note of the type of procedure, date, and any relevant details regarding the outcome.
Point 5: Record medication history
01
Ask about any medications regularly taken by family members.
02
Include the name of the medication, dosage, frequency, and the reasons for taking it.
Point 6: Note mental health conditions
01
Inquire about any mental health issues or disorders within the family.
02
Document the specific condition, age of diagnosis, treatment, and any relevant information.
Point 7: Mention lifestyle factors and habits
01
Ask about lifestyle choices such as smoking, alcohol or drug use, and exercise routine.
02
Include any other relevant habits that may impact overall health.

Point 8: Who needs the health history fami l?

01
Health history fami l is important for everyone in the family.
02
It helps healthcare professionals identify potential risks and understand the underlying health conditions that may be hereditary.
03
It can be vital for proper diagnosis, prevention, and treatment planning.
Remember, it is crucial to maintain privacy and confidentiality when gathering and documenting this sensitive information.
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Health history family is a document that contains information about the medical history of an individual's family members.
Health history family is typically filled out by individuals and their family members, but it may be required by healthcare providers or insurers.
Health history family can be filled out by providing details about the medical conditions, illnesses, and diseases that run in the family.
The purpose of health history family is to provide healthcare providers with valuable information about potential genetic predispositions and risks for certain health conditions.
Information such as medical conditions, illnesses, surgeries, medications, and treatments of family members must be reported on health history family.
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