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Potomac Audiology Child History Form One Central Plaza 11300 Rockville Pike Suite 105 Rockville MD 20852 2404771010 Today's Date: Child's Name: Date of Birth: / / Female Recurrent Age: Contact Information:
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How to fill out potomac audiology child history

01
Start by gathering all necessary information about the child, such as their demographic details (name, age, address), medical history, and any current medical conditions or medications being taken.
02
Begin filling out the child's personal information, such as their name, date of birth, and contact information. Make sure to double-check for any errors or missing information.
03
Move on to documenting the child's medical history. This includes any previous diagnoses, treatments, surgeries, or hospitalizations they have undergone. Provide as much detail as possible to ensure accurate assessment.
04
Record the child's current medications, if any. Include the name of the medication, dosage, frequency, and the reason for taking it.
05
Fill in any specific questions or prompts provided in the Potomac Audiology child history form. These may ask about the child's hearing abilities, speech development, or any concerns or symptoms related to their auditory health.
06
Finally, review the filled-out form for completeness and accuracy. Make any necessary amendments or additions before submitting it to Potomac Audiology.

Who needs potomac audiology child history?

01
Parents or legal guardians of children who are seeking audiology services from Potomac Audiology would need to fill out the Potomac Audiology child history form on behalf of their child.
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Potomac Audiology Child History is a form that collects information about a child's medical and audiological history.
Parents or legal guardians of the child are required to file Potomac Audiology Child History.
Potomac Audiology Child History can be filled out online or in person by providing details about the child's medical and audiological history.
The purpose of Potomac Audiology Child History is to gather important information about a child's health and hearing to assist audiologists in providing appropriate care and treatment.
Information such as the child's medical history, previous hearing test results, any allergies or medications, and family history of hearing loss must be reported on Potomac Audiology Child History.
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