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HEALTH ASSESSMENT SCREENING QUESTIONNAIRE FOR 1218 MONTHS Patients Name: Completed by: Social/Environmental: Relationship to patient: Home occupants (if multiple homes, list separately) Pets Please
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The health assessment screening questionnaire is a form designed to gather information about an individual's health status, behaviors, and risk factors.
Employers are typically required to provide the health assessment screening questionnaire to their employees.
The questionnaire can be filled out by answering the questions honestly and thoroughly, providing accurate information about health and lifestyle.
The purpose of the questionnaire is to assess an individual's health risks and provide information for potential interventions or preventive measures.
Information such as medical history, lifestyle habits, family health history, and current health status may need to be reported on the questionnaire.
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