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FAMILY CARE HEALTH CENTERS
PEDIATRIC PATIENT HISTORY FORM
Name:
LastFirstDate:Middle
Date of Birth:Who is your doctor?
When were you last seen by your previous doctor?
MEDICAL He
Y
N
Y
ALLERGIES
Allergic
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How to fill out who is your doctor
How to fill out who is your doctor:
01
Start by carefully reading the instructions provided on the form. Make sure you understand what information is required and how it should be entered.
02
Begin by entering your personal details such as your full name, date of birth, gender, and contact information. These details help identify you as the patient.
03
Look for the specific field or section on the form that asks for your doctor's information. This may be labeled as "Primary Care Physician" or "Attending Physician." Make sure to locate the correct section to avoid any confusion.
04
Fill in the name of your doctor accurately. If you are unsure of the exact spelling or full name, consult your medical records or contact your doctor's office for assistance. It's important to provide the correct information to avoid any communication or coordination issues with your healthcare provider.
05
Depending on the form, you may also be asked to provide additional details about your doctor, such as their specialty or practice location. Provide this information if it is requested.
06
Once you have filled out all the necessary fields related to who is your doctor, review the information you have entered. Double-check for any errors or omissions before submitting the form. It's essential to provide accurate information to ensure proper documentation and effective communication with your healthcare team.
Who needs who is your doctor:
01
Patients visiting a new healthcare provider or facility: When you visit a new doctor or healthcare facility, they may ask you to fill out a form with your doctor's information. This helps them understand your medical history, any ongoing treatments, and facilitates communication between healthcare providers.
02
Individuals switching primary care physicians: If you have decided to change your primary care physician, you may be required to provide information about your previous doctor on certain forms. This ensures a smooth transition of medical records and helps the new doctor understand your medical history.
03
Emergency situations: In emergency situations, medical professionals might need to know who your regular doctor is to provide necessary medical care. This information can be crucial in understanding your medical background, allergies, ongoing treatments, or any pre-existing conditions that might influence your emergency treatment.
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What is who is your doctor?
Who is your doctor is a form used to report personal medical information.
Who is required to file who is your doctor?
Patients are required to file who is your doctor form.
How to fill out who is your doctor?
You can fill out who is your doctor form by providing your doctor's name, contact information, and medical history.
What is the purpose of who is your doctor?
The purpose of who is your doctor is to maintain accurate medical records.
What information must be reported on who is your doctor?
You must report your doctor's name, contact information, and any relevant medical history.
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