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Medical History Form Client Male Female Date of birth Name of Person Completing this Form Relationship Preferred Language Reason for referral for therapy Parent or Caregiver concerns Birth History Delivery type Vaginal or C-section Vacuum or forceps assisted Yes No Difficulties during pregnancy Yes No If yes please explain Gestational Age Full term or Premature If premature born at weeks Apgar Score if known Duration of hospital stay post birth Did client have any problems with the...
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How to fill out client male female date

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First, access the client's profile form.
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Identify the fields for male, female, and date of client.
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Choose the appropriate option for male or female based on the client's gender.
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Enter the date of birth of the client in the designated date field.
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