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Colorectal Surgery History Forename Appointment Date DOB Age Gender Male FemaleHeight Weight Phone / / (Circle Primary)HomeWorkCellI am a New patient Returning patient, previously seen by Dr. (year)
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How to fill out colorectal surgery history form
How to fill out colorectal surgery history form
01
To fill out the colorectal surgery history form, follow these steps:
02
Start by providing your personal information, such as your name, date of birth, and contact details.
03
Indicate the reason for the surgery by describing your symptoms and medical condition.
04
Mention any previous colorectal surgeries you have undergone, including the dates and details of the procedures.
05
Provide a comprehensive medical history, including any previous illnesses, allergies, and medications you are currently taking.
06
Describe any pre-operative preparations or tests you have done or need to do before the surgery.
07
Outline any specific concerns or questions you have regarding the surgery or post-operative care.
08
Sign and date the form to certify its accuracy and completeness.
09
Make sure to review the form before submission to ensure all necessary information is included.
10
Remember to consult with your healthcare provider if you have any doubts or need assistance in filling out the form.
Who needs colorectal surgery history form?
01
The colorectal surgery history form is typically required for individuals who are scheduled to undergo colorectal surgery.
02
This form helps the healthcare provider understand the patient's previous surgical history, assess the risks associated with the surgery, and plan the appropriate course of treatment.
03
Patients who have experienced colorectal issues or who have undergone previous colorectal surgeries may be required to complete this form to facilitate comprehensive and personalized care.
04
It is important to consult with your healthcare provider or surgeon to determine if you need to fill out the colorectal surgery history form.
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