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NAME DATE OF VISIT APT. WITH MEDICAL HISTORY AGE Y DOB REASON FOR VISIT N EXPLAIN PROVIDER NOTES 1. Eye, ear, nose, throat problems 2. Respiratory: asthma tuberculosis other 3. Cardiac: heart disease

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How to fill out eye ear nose throat

01

Wash your hands before touching your eye, ear, nose, or throat.

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Use a clean tissue or cotton swab to gently clean the outer part of your ear.

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To fill out your eye, use clean hands or a clean cotton swab.

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Anyone experiencing eye discomfort, ear infections, nasal congestion, or throat soreness might need to seek help from a specialist or healthcare provider who specializes in eye, ear, nose, and throat issues.

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Individuals with allergies, sinus problems, respiratory infections, or frequent sore throats may also benefit from consulting an eye ear nose throat specialist.

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What is eye ear nose throat?

Eye ear nose throat refers to a medical specialty that focuses on the diagnosis and treatment of issues related to the eyes, ears, nose, and throat.

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Medical professionals specializing in ophthalmology, otolaryngology, and related fields are typically required to file reports related to eye ear nose throat.

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Information reported on eye ear nose throat forms may include patient demographic information, medical history, examination findings, diagnostic test results, treatment plans, and follow-up care.

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