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HEALTH HISTORY SURGICAL ASSOCIATES, PC 575 S. 70th Street, Suite 310 Lincoln, NE 68510 Date: Name Age Gender: M / F Family Doctor: Sent to our office by: Reason for seeing doctor: Problem/Symptoms:
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Start by collecting all relevant medical documents and records of past surgeries.
02
Carefully read and understand the instructions provided by Health History Surgical Associates.
03
Fill out the personal information section, including your name, contact details, and date of birth.
04
Provide accurate details about your medical history, including any chronic illnesses, allergies, or previous surgeries.
05
If you have any current medications or ongoing treatments, mention them in the appropriate section.
06
Answer all the questions regarding your lifestyle choices, such as smoking or alcohol consumption.
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If you have any specific concerns or additional information to convey, make sure to note them in the designated space.
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Double-check all the information provided to ensure accuracy.
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Sign and date the health history form to signify its completion.
10
Submit the filled out health history form to the Health History Surgical Associates either digitally or physically as per their instructions.

Who needs health historysurgical associates?

01
Anyone who requires a surgery or medical procedure from Health History Surgical Associates will need to fill out the health history form.
02
Patients who want to ensure that accurate and comprehensive information is available to their healthcare providers for proper assessment and treatment will also benefit from filling out the form.
03
Health History Surgical Associates may require all patients, regardless of the specific procedure, to complete this form to maintain a standardized medical record.
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Health history surgical associates is a document that records an individual's past surgeries and medical procedures.
All patients undergoing a surgical procedure are required to file health history surgical associates.
Health history surgical associates can be filled out by providing details of any past surgeries, medical conditions, and medications.
The purpose of health history surgical associates is to provide doctors with important information about a patient's medical background before a surgical procedure.
Information such as past surgeries, medical conditions, allergies, medications, and any previous complications must be reported on health history surgical associates.
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