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EXHIBIT ENTRY FORM Date submitted: (Submit by August 15, 2017) Category:Doctors Health EducationMedical HeritageName/Title of Project: COUNTY PROJECT: Name of Auxiliary/Alliance: Number of Members:
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How to fill out medical heritage

01
Gather all necessary documents and information related to your medical history.
02
Start by filling out your personal information such as name, date of birth, and contact details.
03
Provide details about your family medical history, including any hereditary diseases or conditions.
04
List down any major illnesses or surgeries you have had in the past, along with the dates and medical professionals involved.
05
Include information about any ongoing medical conditions or allergies you may have.
06
Mention any medications you are currently taking, including dosage and frequency.
07
Don't forget to mention any mental health concerns or past treatments.
08
Complete the form by reviewing all the provided information for accuracy.
09
If unsure about any particular item, consult with your healthcare provider for clarification.
10
Make sure to keep a copy of your filled-out medical heritage for future reference.

Who needs medical heritage?

01
Anyone seeking medical care or treatment should have a medical heritage.
02
Individuals with chronic illnesses or ongoing medical conditions greatly benefit from maintaining a medical heritage.
03
People with a family history of hereditary diseases or conditions should have a medical heritage to provide valuable information to their healthcare providers.
04
Elderly individuals who may be more prone to medical issues should also have a medical heritage.
05
Emergency situations or visits to new healthcare providers often require providing a medical heritage.
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Medical heritage refers to the history of health conditions and genetic traits within a family.
Individuals with knowledge of their family's medical history are typically required to report their medical heritage.
Medical heritage can be filled out by providing detailed information about any health conditions, diseases, and genetic traits that run in the family.
The purpose of medical heritage is to help healthcare professionals assess and manage the risk of certain health conditions in individuals based on their family history.
Information such as significant health conditions, diseases, and genetic traits that have occurred in the family should be reported on medical heritage.
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