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Submit by Email Print Form Puget Sound Psychiatric Center, P.S. 10634 E Riverside Drive, Suite 130 Bothell, WA. 98011 Tel: (425) 806-5021 Fax: (425) 486-3949 Patient s Name: Initial Contact Questionnaire
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How to fill out new patient history and
How to fill out new patient history:
01
Start by providing personal information such as your full name, date of birth, address, and contact details.
02
Next, detail your medical history, including any past and current medical conditions, surgeries, or hospitalizations.
03
Mention any medications you are currently taking, including prescribed medications, over-the-counter drugs, and vitamins or supplements.
04
Provide information about any known allergies, both medication allergies and allergies to substances like pollen or food.
05
Include a family medical history section, documenting any hereditary conditions or diseases that run in your family.
06
Mention any lifestyle factors that may affect your health, such as smoking, alcohol consumption, or physical activity level.
07
If you have any previous medical records or test results, bring them to your appointment or provide copies along with your history form.
Who needs new patient history:
01
Any individual who is visiting a healthcare provider for the first time will need to fill out a new patient history form. This could include someone seeking primary care, specialized care, or even dental care.
02
Patients who have recently moved or changed healthcare providers may be required to fill out a new patient history form to ensure accurate and up-to-date medical information.
03
It is essential for individuals who are starting a new medical treatment or medication to provide a comprehensive medical history to their healthcare provider, as it helps determine the appropriate course of action.
In conclusion, filling out a new patient history form is crucial for anyone seeking healthcare services, as it provides healthcare providers with essential information about your medical background and assists them in providing appropriate care.
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What is new patient history and?
New patient history is a form that collects medical information about a patient who is visiting a healthcare provider for the first time.
Who is required to file new patient history and?
Healthcare providers are required to file new patient history for all new patients.
How to fill out new patient history and?
New patient history can be filled out by providing accurate medical information about the patient's previous medical history, current medications, allergies, and any other relevant details.
What is the purpose of new patient history and?
The purpose of new patient history is to provide healthcare providers with essential information to ensure quality care and accurate diagnosis for new patients.
What information must be reported on new patient history and?
Information such as previous medical history, current medications, allergies, family medical history, and any relevant details about the patient's health should be reported on new patient history.
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