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HISTORY AND INTAKE FORM
PATIENT NAME:
DOB: DATE:
PAST MEDICAL HISTORY
(please circle all that apply)Asthma
Hyperthyroidism (high thyroid level)
Atrial fibrillation
Hypothyroidism (low thyroid level)
Bone
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01
To fill out dobdate, follow these steps:
02
Start by locating the section for date of birth (DOB) on the form or document.
03
Enter the month of birth in the designated space. Use the numerical representation (e.g., '01' for January).
04
Enter the day of birth in the designated space. Again, use the numerical representation (e.g., '20' for the 20th day of the month).
05
Enter the year of birth in the designated space. Use the full numerical representation (e.g., '1985').
06
Double-check the accuracy of the entered DOB to ensure it is correct.
07
Submit the completed form or document with the filled out dobdate section.
Who needs dobdate?
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Anyone who is required to provide their date of birth on a form or document needs dobdate.
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Examples of individuals who may need dobdate include:
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- Applicants applying for a job or educational program
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- Patients filling out medical forms
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- Individuals applying for government identification or benefits
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- Individuals creating online accounts or profiles
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What is dobdate?
Dobdate stands for Date of Birth and it is the date on which a person was born.
Who is required to file dobdate?
Any individual or entity that requires information related to Date of Birth is required to file dobdate.
How to fill out dobdate?
Dobdate can be filled out by providing the accurate Date of Birth information of the individual.
What is the purpose of dobdate?
The purpose of dobdate is to accurately record and maintain Date of Birth information for individuals.
What information must be reported on dobdate?
The information reported on dobdate must include the complete Date of Birth of the individual.
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