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THE HEBREW UNIVERSITY OF JERUSALEM ROTHBARD INTERNATIONAL SCHOOL Summer Courses and Special Programs Report of Medical Examination Please keep in mind that we do not accept forms completed by a relative.

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1. First, ensure that you have the necessary medical form - Rothberg. This form may be required by medical facilities or healthcare providers for various purposes, such as medical history documentation or new patient registration.
2. Start by carefully reading through the form, paying close attention to any instructions or guidelines provided. This will help you understand what information should be included and how it should be formatted.
3. Begin filling out the form by providing your personal information, such as your full name, date of birth, contact details, and any other relevant identifiers. Make sure to write legibly and use accurate and up-to-date information.
4. If the form asks for your medical history, provide details about any past and current medical conditions, allergies, medications, surgeries, or treatments. Be as specific as possible, including dates if necessary.
5. In case the medical form includes sections regarding your family medical history, indicate whether there have been any significant conditions or diseases within your immediate family, including parents, siblings, or children.
6. If there is a section for your current medications, accurately list the names, dosages, and frequencies of any prescription drugs, over-the-counter medications, or supplements you are currently taking.
7. Provide information about your primary care physician or any specialists you regularly see. Include their names, contact information, and the reason for your visits to them.
8. If applicable, disclose any previous hospitalizations or emergency room visits, including the reasons and dates of these visits. Additionally, mention any chronic conditions you may have.
9. Read the form thoroughly for any additional sections specific to your circumstances, such as questions related to occupational or travel history, lifestyle habits, or insurance information. Respond to these sections accordingly.

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1. Individuals visiting a new healthcare provider for the first time may need to fill out a medical form - Rothberg. This helps the provider understand their medical history and current health status.
2. Patients undergoing medical treatments or procedures, such as surgeries or medications, may be required to complete a medical form - Rothberg to ensure that the treatment is safe and appropriate for their health condition.
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Remember, the specifics of who needs a medical form - Rothberg may vary depending on the requirements of the healthcare provider or institution.

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