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2017 SUMMER HIGH SCHOOL PROGRAM I M P O R TA N T Health History and Examination Form This form must be completed for attendance. Photocopy of front and back of health insurance card must be attached
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Step 1: Start by gathering all necessary information. This includes personal details such as name, date of birth, and contact information.
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Step 2: Provide information about your medical history. Include any past illnesses, surgeries, or medical conditions that you have been diagnosed with.
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Step 3: Detail your current medication. List any prescription drugs, over-the-counter medications, vitamins, or supplements that you are currently taking.
04
Step 4: Mention any allergies or adverse reactions you have experienced. This includes food allergies, drug allergies, and any known sensitivities.
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Step 5: Provide information about your family medical history. Include details about any hereditary diseases or conditions that may run in your family.
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Step 6: Fill in your lifestyle habits. Mention if you smoke, consume alcohol, or engage in any other habits that may be relevant to your health.
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Step 7: Finish by signing and dating the health history form.
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Step 8: Make sure to review the form for accuracy before submitting it.

Who needs health history - landmark?

01
Anyone who visits a healthcare professional at the landmark clinic needs to fill out a health history form.
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New patients who want to establish medical care at the landmark clinic are required to provide their health history.
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Patients who are undergoing a surgical procedure or starting a new treatment plan at the landmark clinic also need to provide their health history.
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Existing patients who have not filled out a health history form in the past year may be requested to update their information.
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Health history - landmark refers to the detailed medical information of an individual, including past illnesses, treatments, and family history.
All individuals are required to file health history - landmark, regardless of age or health condition.
Health history - landmark can be filled out online through the designated portal, by providing accurate and up-to-date medical information.
The purpose of health history - landmark is to provide healthcare providers with a comprehensive overview of an individual's medical background, aiding in better diagnosis and treatment.
Health history - landmark must include details of past illnesses, surgeries, medications, allergies, and family medical history.
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