Get the free 145008 FMMG Ortho Pt Intake Form - Floyd Memorial

Floyd Memorial Medical GroupOrthopedics 1919 State Street, Suite 104 New Albany, IN 47150 (812) 944BONE (2663) Patient Intake Form It is important you complete all sections Name: Appointment Date:

How to fill out 145008 fmmg ortho pt

Instructions for filling out 145008 fmmg ortho pt:

1. Start by writing the patient's personal information at the top of the form, including their name, date of birth, and contact details.
2. Fill out the medical history section, providing details about any past or existing medical conditions, surgeries, or allergies. It is important to be thorough and accurate when documenting this information.
3. Include information about the patient's current medications, including prescription drugs, over-the-counter medications, and any supplements they may be taking. Note the dosage and frequency of each medication.
4. Document any ongoing or recent injuries related to the orthopedic condition being treated. Include details such as the date of injury, the circumstances surrounding it, and any treatments received.
5. Describe the symptoms the patient is experiencing in relation to the orthopedic condition. This may include details about pain, range of motion limitations, and any other relevant information.
6. Note any previous treatments the patient has received for the orthopedic condition, such as physical therapy, injections, or surgery. Include the dates, healthcare providers involved, and any outcomes or complications.
7. Ensure that all fields and sections of the form are completed accurately and legibly. Double-check for any possible errors or omissions before submitting the form.

Who needs 145008 fmmg ortho pt?

1. Patients who are seeking orthopedic treatment or evaluation for a specific condition or injury may need to fill out the 145008 fmmg ortho pt form. This form is commonly used in orthopedic clinics or when being referred to an orthopedic specialist.
2. Individuals who have experienced orthopedic injuries or are suffering from musculoskeletal conditions, such as fractures, sprains, strains, arthritis, or joint pain, may be required to complete the 145008 fmmg ortho pt form.
3. This form is necessary for healthcare providers to gather detailed information about the patient's medical history, current symptoms, and previous treatments related to their orthopedic condition. It helps the healthcare team to assess the patient's needs accurately and provide appropriate care and treatment options.

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