Get the free MEDICAL HISTORY STATEMENT - nletc.nebraska.gov
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MEDICAL HISTORY STATEMENT THIS INFORMATION IS FOR OFFICIAL USE ONLY AND WILL NOT BE RELEASED TO UNAUTHORIZED PERSONS. INSTRUCTIONS: To be completed by applicant for a position as a law enforcement
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How to fill out medical history statement
How to fill out medical history statement
01
Ensure you have the necessary documents and forms. This includes the medical history statement form provided by the healthcare provider.
02
Start by providing your personal information. This includes your full name, date of birth, address, and contact details.
03
Next, fill in your medical history. Begin with any previous medical conditions you have been diagnosed with, including allergies, chronic illnesses, surgeries, or hospitalizations.
04
Include details about any medications you are currently taking or have taken in the past. Mention the dosage, frequency, and duration of each medication.
05
Provide information about your family medical history. This includes any genetic conditions or hereditary diseases that may run in your family.
06
Answer questions regarding your lifestyle habits such as smoking, alcohol consumption, and exercise routine.
07
Disclose any known allergies or adverse reactions you may have to medications, food, or other substances.
08
Include information about your immunization history, including the dates of any vaccinations received.
09
If applicable, mention any current or previous pregnancies, including complications or miscarriages.
10
Finally, review the completed form before submitting it to ensure accuracy and completeness.
Who needs medical history statement?
01
Anyone seeking medical care or treatment may need to fill out a medical history statement.
02
New patients visiting a healthcare provider for the first time are usually required to provide a medical history statement.
03
Individuals undergoing medical procedures or surgeries may be asked to fill out a medical history statement to assess their suitability for the procedure.
04
Medical professionals may need a patient's medical history statement to accurately diagnose and treat any existing conditions.
05
Emergency medical responders may require a medical history statement to quickly understand a patient's medical background in critical situations.
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