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Stacie Castle, MS, RD, CDN (516) 6522747 Medical and Nutrition History Form Name Date Marital Status Age Reason for today's visit # of people living in your household # of children Check off any Health

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What is medical and nutrition history?

Medical and nutrition history is a record of an individual's past and current medical conditions, treatments, surgeries, medications, allergies, dietary habits, and nutritional needs.

Who is required to file medical and nutrition history?

Medical and nutrition history is typically required to be filed by healthcare providers, dietitians, nutritionists, and individuals seeking medical treatment or nutritional guidance.

How to fill out medical and nutrition history?

Medical and nutrition history can be filled out by providing accurate and detailed information about past and current medical conditions, medications, allergies, dietary habits, and nutritional needs.

What is the purpose of medical and nutrition history?

The purpose of medical and nutrition history is to assist healthcare providers, dietitians, and nutritionists in assessing and addressing an individual's medical conditions, dietary habits, and nutritional needs.

What information must be reported on medical and nutrition history?

Information that must be reported on medical and nutrition history includes past and current medical conditions, treatments, surgeries, medications, allergies, dietary habits, and nutritional needs.

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