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Ricks Advanced Dermatology Adolescent/Young Adult History and Intake Form Patient Name: DOB: Email: Past Medical History: (please circle all that apply) Depression Polycystic Ovary Acne Hepatitis
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How to fill out adolescent history and intake

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How to fill out adolescent history and intake:

01
Gather all necessary personal information, including the adolescent's full name, date of birth, address, and contact information.
02
Record details about the adolescent's medical history, including any past illnesses, surgeries, or hospitalizations.
03
Document the adolescent's current medications, including dosage and frequency.
04
Inquire about any known allergies or adverse reactions to medications.
05
Ask about the adolescent's immunization history and ensure all vaccinations are up to date.
06
Discuss the adolescent's family medical history, including any hereditary conditions or diseases that run in the family.
07
Record information about the adolescent's mental health, including any previous diagnoses, treatments, or therapy.
08
Inquire about the adolescent's sexual health and relationships if relevant.
09
Ask about the adolescent's substance use or tobacco habits if applicable.
10
Include questions about the adolescent's diet, exercise routine, and overall lifestyle.

Who needs adolescent history and intake?

Adolescent history and intake forms are typically required by healthcare professionals, such as doctors, pediatricians, psychologists, therapists, or counselors who need a comprehensive understanding of the adolescent's medical background, personal habits, and lifestyle. These forms are crucial for assessing and managing the adolescent's physical and mental health. Additionally, schools, sports teams, or other organizations working with adolescents may also require such information to ensure the safety and well-being of the individual.
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Adolescent history and intake is a form or document that gathers information about an adolescent's background, medical history, and current needs.
Healthcare providers, social workers, or caregivers who are responsible for the well-being of adolescents are required to file adolescent history and intake.
Adolescent history and intake forms can be filled out by providing accurate information about the adolescent's personal details, medical history, behavioral issues, and any other relevant information.
The purpose of adolescent history and intake is to gather comprehensive information about an adolescent's background, health, and needs in order to provide appropriate care and support.
Information such as the adolescent's personal details, medical history, mental health history, behavioral issues, family background, and current needs must be reported on adolescent history and intake.
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