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Pediatric Initial Encounter Form v4.8Date / /Name:Mothers Name:AMP ATH Hospital ID:Mothers AMP ATH ID:1. Date of Birth: If Birth date Unknown, Age at last Birthday: If 1year, months 2. Sex: M F3.
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Pediatric initial encounter form is a document used to record the first encounter of a child with a healthcare provider.
Parents or guardians of the child are required to file the pediatric initial encounter form.
The pediatric initial encounter form can be filled out by providing the child's personal information, medical history, and the reason for the visit.
The purpose of pediatric initial encounter form is to create a record of the child's medical history and to track their progress throughout their healthcare journey.
The pediatric initial encounter form must include the child's name, date of birth, medical conditions, allergies, medications, and insurance information.
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