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HEALTH RECORD / WELLNESS CHECK FORM **Must Be Completed by Child's Physician** Child's Name Birthdate Address Phone # Health Information Tuberculosis test? Y / N Date Results Chest ray? Date Results
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Start by carefully reading the instructions provided on the form.
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Fill in your personal information accurately, such as your name, date of birth, and contact details.
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Answer the questions regarding your current health condition, including any symptoms you may be experiencing.
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Who needs wellness check form:

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Individuals who are planning to participate in certain activities or events where health monitoring is necessary, such as sports competitions or travel.
Note: The specific requirements for who needs a wellness check form may vary depending on the organization or situation.
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A wellness check form is a document used to assess the health and well-being of individuals, particularly in healthcare settings, to ensure they are receiving appropriate care and support.
Typically, healthcare providers, social workers, or caregivers are required to file a wellness check form, especially when there are concerns about a patient's health or living conditions.
To fill out a wellness check form, provide necessary personal information about the individual being checked, including their name, age, health history, and any specific concerns or observations that prompted the check.
The purpose of a wellness check form is to monitor and evaluate an individual's health status, identify any areas that may need attention, and ensure that they are safe and receiving proper care.
The wellness check form must report information such as the individual's personal details, medical history, current health status, any immediate health concerns, and observations made during the check.
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