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LES Medical History and Examination Form (Form para LES Examen e Historical Medico) PART 1 Employee Information (to be completed by the employee) Part 1 (A SER completed PO Rel plead) 1. Name (Last,

How to fill out les medical history and

How to fill out LES medical history:

1. Start by gathering all relevant medical information: Before filling out the LES medical history form, make sure you have access to all the necessary medical records, including previous diagnoses, medications taken, and any past surgeries or procedures.
2. Provide accurate personal information: Begin by filling out your personal details accurately, including your full name, date of birth, gender, and contact information. Double-check to ensure that all information provided is correct.
3. Specify existing medical conditions: In this section, list any current medical conditions you have been diagnosed with. Be thorough and provide details about each condition, including the dates of diagnosis, any treatments received, and the names of healthcare professionals involved in your care.
4. Document medication history: Provide a comprehensive list of all medications you are currently taking, including prescription drugs, over-the-counter medications, vitamins, and supplements. Include the dosage, frequency, and the reason for taking each medication.
5. Record any allergies or adverse reactions: Indicate any known allergies or adverse reactions you have experienced in the past. This includes drug allergies, food allergies, and any reactions to environmental factors or medical procedures.
6. Mention previous surgeries or medical procedures: List any surgeries or medical procedures you have undergone in the past. Include the dates, the name of the healthcare provider or facility, and the reason for the procedure.
7. Provide family medical history: Include information about any significant medical conditions that run in your family. This can help healthcare professionals identify potential genetic risks or hereditary diseases.

Who needs LES medical history:

1. Patients visiting a new healthcare provider: When visiting a new healthcare provider, you may be required to fill out a LES medical history form. This provides the physician with crucial background information to understand your medical background and provide appropriate care.
2. Individuals participating in research studies or clinical trials: Research studies and clinical trials often require participants to provide detailed medical histories. This information helps researchers identify suitable participants and determine the impact of certain conditions on the study's outcomes.
3. Individuals applying for life insurance or disability benefits: When applying for life insurance or disability benefits, insurance companies typically request medical history information. It allows them to assess the applicant's risk level and determine appropriate coverage or premiums.

In summary, filling out the LES medical history form requires collecting accurate personal information, detailing existing medical conditions, providing medication history, documenting allergies, noting previous surgeries or procedures, and disclosing family medical history. It is typically required by new healthcare providers, research studies, and insurance companies.

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