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Iran Wellness Medical Center, Inc. Karima Iran MD, MPH MEDICAL AND HEALTH HISTORY QUESTIONNAIRE Please complete this form prior to your visit. Bring it with you the day of your visit. Please do not
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Start by gathering all necessary personal information, including your full name, date of birth, address, and contact information.
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Provide your medical history, including any previous diagnoses, medications you are currently taking, and previous treatments.
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Fill out the insurance information section, including your insurance provider, policy number, and any applicable co-pays or deductibles.
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Specify your reason for visiting the Hirani Wellness Medical Center, whether it is for a specific illness or general check-up.
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Fill out any additional sections or forms as required by the medical center, such as consent forms or privacy policies.
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The medical center is open to both new patients seeking primary care and individuals in need of specialized services provided by the center's team of healthcare professionals.
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Hirani Wellness Medical Center is a facility that provides medical services focused on holistic wellness.
Medical professionals and staff at Hirani Wellness Medical Center are required to file relevant documents and reports.
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The purpose of Hirani Wellness Medical Center is to provide holistic medical services and promote overall wellness.
Information such as patient data, treatment procedures, and outcomes must be reported on Hirani Wellness Medical Center documents.
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