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Dr V Patel Surgery 9 Glanville Drive Hornchurch RM11 3SZ 01708 442117 www. drvpatelsurgery. nhs. uk In order to be fully registered with Dr V Patel this form MUST be completed by the parent/guardian NEW PATIENT HEALTH QUESTIONNAIRE TITLE FOR 6 TO 15 YEAR OLDS FIRST NAME SURNAME DATE OF BIRTH GENDER ADDRESS incl flat no ANY OTHER SURGERY PATIENTS LIVING AT THIS ADDRESS IS YOUR CHILD THE LONE OR PARTIAL CARER FOR SOMEONE If yes please specify HOME TEL M F please tick Please give names YES NO...
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How to fill out new patient health questionnaire
How to fill out new patient health questionnaire
01
Read and understand the questions on the new patient health questionnaire.
02
Provide accurate and complete information for each question.
03
Fill out all the required fields and ensure all necessary information is provided.
04
Double-check your answers before submitting the form.
05
If you have any questions or need assistance, ask a healthcare professional or the staff at the healthcare facility.
Who needs new patient health questionnaire?
01
New patients who are visiting a healthcare facility for the first time.
02
Patients who have not previously provided their health information to the healthcare facility.
03
Individuals undergoing a medical examination or procedure.
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What is new patient health questionnaire?
The new patient health questionnaire is a form that collects important health information from individuals who are new patients at a healthcare facility.
Who is required to file new patient health questionnaire?
All new patients at a healthcare facility are required to fill out a new patient health questionnaire.
How to fill out new patient health questionnaire?
To fill out a new patient health questionnaire, individuals need to provide accurate information about their medical history, current health status, and any medications they are taking.
What is the purpose of new patient health questionnaire?
The purpose of the new patient health questionnaire is to help healthcare providers assess a patient's health status, identify any potential risks or health conditions, and provide appropriate care.
What information must be reported on new patient health questionnaire?
Information such as medical history, current health conditions, allergies, medications, and contact information must be reported on the new patient health questionnaire.
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