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HISTORY AND INTAKE FORM
PATIENT NAME:
DOB:DATE:
PAST MEDICAL HISTORY
(please circle all that apply)Asthma
Hyperthyroidism (high thyroid level)
Atrial fibrillation
Hypothyroidism (low thyroid level)
Bone
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What is hyperthyroidism high thyroid level?
Hyperthyroidism is a condition where the thyroid gland is overactive and produces an excess of thyroid hormones.
Who is required to file hyperthyroidism high thyroid level?
Individuals who have been diagnosed with hyperthyroidism by a healthcare provider are required to file a high thyroid level report.
How to fill out hyperthyroidism high thyroid level?
To fill out a hyperthyroidism high thyroid level report, individuals must provide details of their diagnosis, medication, and any related symptoms.
What is the purpose of hyperthyroidism high thyroid level?
The purpose of the hyperthyroidism high thyroid level report is to monitor and track the thyroid hormone levels of individuals with hyperthyroidism.
What information must be reported on hyperthyroidism high thyroid level?
Information such as thyroid hormone levels, medication dosage, symptoms, and any changes in condition must be reported on the hyperthyroidism high thyroid level form.
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