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ONLINEConfidential medical information Rev Sept 14PART A: ABOUT YOU Please answer the questions on this form in BLOCK CAPITAL letters using BLACK Entitle:Surname:Date of Birth:(Mr, Mrs, Miss, Other?)
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Provide personal information such as name, age, and contact details.
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Answer the medical history questions honestly and accurately.
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An online medical questionnaire is a form or survey that patients fill out electronically to provide their medical history and information to healthcare providers.
Patients or individuals seeking medical treatment or consultation are required to fill out online medical questionnaire.
Patients can fill out an online medical questionnaire by accessing the website or portal provided by their healthcare provider, entering their information, and submitting the form electronically.
The purpose of online medical questionnaire is to provide healthcare providers with accurate and comprehensive information about a patient's medical history, current health conditions, and medications.
Patients must report their personal information, medical history, current health conditions, allergies, medications, and any other relevant information requested by the healthcare provider on the online medical questionnaire.
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