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Dental Implants & Periodontics of Connecticut Please visit us www.docfloss.com Name How would you like to be addressed? Address City State Zip Code Home () Work () Cell /Pager () Email Address Do
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How to Fill Out Health History - New:

01
Start by gathering all necessary information such as personal details, contact information, and insurance details.
02
List any pre-existing medical conditions or chronic illnesses that you have been diagnosed with.
03
Provide details about any surgeries, hospitalizations, or significant medical procedures you have undergone in the past.
04
Make a record of any allergies or adverse reactions you have experienced to medications, foods, or environmental substances.
05
Include any current medications or supplements you are taking, along with the dosage and frequency.
06
Note any family history of medical conditions, such as heart disease, cancer, or diabetes.
07
Mention any lifestyle habits that may impact your health, such as smoking, excessive alcohol consumption, or a sedentary lifestyle.
08
Be honest and thorough when filling out the health history form to provide healthcare professionals with accurate information.

Who Needs Health History - New:

01
Individuals visiting a new healthcare provider for the first time.
02
Patients undergoing a medical procedure or surgery.
03
Individuals seeking to update their medical records.
04
Individuals applying for health insurance coverage.
05
Individuals participating in clinical research studies or trials.
06
Individuals experiencing new or worsening symptoms and seeking medical advice.
07
Individuals transitioning between healthcare providers or specialists.
08
Individuals starting a new job that requires health screening or a physical examination.
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Health history - new refers to updated information on an individual's past medical conditions, treatments, surgeries, medications, and family medical history.
All individuals are required to file health history - new, regardless of age or health status.
Health history - new can be filled out online through a secure portal provided by the healthcare provider, or in person at a doctor's office.
The purpose of health history - new is to ensure that healthcare providers have the most up-to-date information on an individual's health status, in order to provide appropriate care and treatment.
Information that must be reported on health history - new includes any changes in medical conditions, medications, surgeries, and family medical history.
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