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HISTORY & PHYSICAL FORM CYNTHIA S. FERRELL, D.P.M., N.M.D. 330 HARRIS HILL ROAD WILLIAMSVILLE, NY 14221 7166311133 Fax 7166313030 Please read & complete front/back of all pages PRIOR to you're apt.
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How to fill out history amp physical form
How to fill out history amp physical form:
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Start by providing your personal information, including your full name, date of birth, and contact details.
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Next, fill in your medical history, including any previous illnesses, surgeries, or medical conditions you have had. Be sure to include the dates and details of each event.
03
Provide information about your current medications, including the name, dosage, and frequency of each medication you are taking.
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Detail any known allergies or adverse reactions you have had to medications or other substances in the past.
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Record your family medical history, including any hereditary conditions or diseases that run in your family.
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Answer questions related to your lifestyle choices, such as smoking, alcohol consumption, and exercise habits.
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Specify any current symptoms or concerns you have, including any pain, discomfort, or changes in your health.
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Finally, sign and date the form to confirm its accuracy and completeness.
Who needs history amp physical form:
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Individuals undergoing pre-employment screenings or physical examinations for certain job positions or industries may be required to complete a history amp physical form.
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Students participating in school sports or extracurricular activities that carry a potential risk of injury may need to fill out this form.
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Patients preparing for elective surgeries or medical procedures often need to provide their medical history and undergo a physical examination. The history amp physical form helps gather relevant information for the healthcare provider.
Remember, it is always best to consult with the specific organization or healthcare provider requesting the form to determine if and when it is necessary for you to complete a history amp physical form.
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What is history amp physical form?
The History and Physical form is a document used to record a patient's medical history and current physical condition.
Who is required to file history amp physical form?
Healthcare providers and medical facilities are required to file history and physical forms for their patients.
How to fill out history amp physical form?
History and physical forms are typically filled out by the healthcare provider during a patient's initial visit or pre-operative evaluation.
What is the purpose of history amp physical form?
The purpose of the history and physical form is to provide a comprehensive overview of the patient's medical history and current physical condition.
What information must be reported on history amp physical form?
The history and physical form typically includes information such as the patient's medical history, current medications, allergies, and vital signs.
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