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COLON HISTORY/EXAM/SCREENING FORM PROVIDER CLINIC DOS Client Name DOB FEMALE MALE COLON HEALTH HISTORY Have you ever been diagnosed with any of the following conditions Ulcerative colitis Crohn s colitis Hereditary colon cancer syndromes such as HNPCC None Are you here today for any of the following reasons Lower abdominal pain bright red blood per rectum marked change in bowel habits bloody stools or unexplained weight loss Yes No A YES RESPONSE TO ANY OF THE ABOVE QUESTIONS INDICATES THE...
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WBCHP exam form stands for Work-Based Child Health Program exam form. It is a form used to assess the health of children in a work-based childcare setting.
Employers who operate work-based childcare programs are required to file WBCHP exam form for each child in their care.
WBCHP exam form can be filled out by a healthcare provider who conducts a physical exam on each child in the work-based childcare program.
The purpose of WBCHP exam form is to ensure that children in work-based childcare programs are healthy and receiving appropriate care.
WBCHP exam form requires reporting of the child's medical history, physical exam findings, and any necessary follow-up care recommendations.
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