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PATIENT HISTORY QUESTIONNAIRE OT Date Name DOB Age Hand Dominance Date of Next Visit with Referring Doctor Family Doctor Employer/Occupation Leisure Activities Describe the reason you are here Date
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What is patient history questionnaire?
Patient history questionnaire is a form filled out by patients to provide information about their medical history, current medications, allergies, and other relevant health information.
Who is required to file patient history questionnaire?
Patients who are seeking medical treatment or care from a healthcare provider are required to fill out and submit a patient history questionnaire.
How to fill out patient history questionnaire?
Patients can fill out the patient history questionnaire by providing accurate and detailed information about their medical history, current medications, allergies, and any other relevant health information requested on the form.
What is the purpose of patient history questionnaire?
The purpose of a patient history questionnaire is to provide healthcare providers with important information about a patient's medical history, which helps in delivering safe and effective care.
What information must be reported on patient history questionnaire?
Patients must report information such as their medical history, current medications, allergies, past surgeries, family medical history, lifestyle choices, and any other relevant health information requested on the form.
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