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INITIAL VISIT QUESTIONNAIRE Bruce A. Deposits, MD Robert Rabinovitz, DO Mary George, MD Sara AxelrodMalagold, MD Allergy, Asthma, and Clinical Immunology Stephanie Giles, NP 1540 Highway 138 West
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How to fill out initial visit questionnaire

01
Read the initial visit questionnaire thoroughly to understand the information required.
02
Collect all necessary documents and information before starting the questionnaire.
03
Begin by providing your personal details such as your name, address, and contact information.
04
Answer all the questions accurately and honestly based on your medical history and current health status.
05
If a question is not applicable, mark it as N/A or leave it blank if it is not mandatory.
06
Provide details about any medications you are currently taking, including dosage and frequency.
07
Answer any questions related to your lifestyle, including exercise habits and dietary preferences.
08
Make sure to add any known allergies or sensitivities to medications or substances.
09
If there is a section for medical conditions, list any diagnosed conditions or health concerns.
10
Fill in information regarding your previous medical history, surgeries, or hospitalizations, if applicable.
11
If you are unsure about any question, consider seeking clarification from the healthcare provider.

Who needs initial visit questionnaire?

01
Anyone scheduling an initial visit with a healthcare provider.
02
New patients who have not previously filled out a similar questionnaire.
03
Individuals seeking comprehensive healthcare services or treatments.
04
Patients transitioning to a new healthcare facility or provider.
05
Those with complex medical conditions or extensive medical history.
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The initial visit questionnaire is a form that collects basic information about a client or patient during their first visit to a healthcare provider.
The healthcare provider or their staff is required to file the initial visit questionnaire for each new client or patient.
The initial visit questionnaire can be filled out by the client/patient themselves or by a healthcare provider or their staff during the first visit.
The purpose of the initial visit questionnaire is to gather essential information about the client/patient's medical history, current health status, and any specific issues or concerns.
The initial visit questionnaire may include personal details, medical history, current medications, allergies, lifestyle habits, and any specific health concerns.
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