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MEDICAL HISTORY Page 1 Please take a few minutes to fill out our health history form. PLEASE fill in all areas, FRONT AND BACK, BEFORE YOUR APPOINTMENT. Your answers will help the provider plan and
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How to fill out medical history page 1

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Start by reading the instructions on the medical history page 1 carefully.
02
Fill in your personal information accurately, including your full name, date of birth, and contact details.
03
Provide information about your current health status, including any current medical conditions, medications you are taking, and any allergies you have.
04
Answer the questions about your medical history, including any past surgeries, hospitalizations, or major illnesses.
05
Provide details about your family medical history, such as any genetic diseases or conditions that run in your family.
06
Fill in information about your lifestyle, including your smoking or drinking habits, and any regular exercise you do.
07
Review your answers carefully to ensure accuracy and completeness.
08
Sign and date the medical history page 1 to confirm that all the information provided is true and accurate.

Who needs medical history page 1?

01
Anyone who is seeking medical care or treatment needs to fill out medical history page 1. This includes both new patients and existing patients who have not previously completed the form.
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Medical history page 1 is a form used to document a patient's past and current medical conditions, treatments, surgeries, and medications.
Patients are typically required to fill out and file medical history page 1 before their appointment with a healthcare provider.
Patients can fill out medical history page 1 by providing accurate and detailed information about their medical history, including any known conditions, medications, allergies, and surgeries.
The purpose of medical history page 1 is to provide healthcare providers with important information about a patient's health background, which can help guide their treatment decisions and ensure patient safety.
Information that must be reported on medical history page 1 includes medical conditions, surgeries, medications, allergies, family history, and lifestyle habits.
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