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BREAST QUESTIONNAIRE Patient Name: DOB: Referring Physician: Date of next physician visit: Last 4 numbers of SS#: YES NO 1. Are you pregnant? 2. Do you have a family history of breast cancer? Age
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To fill out the breast questionnaire, follow these steps:
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Start by reading each question carefully.
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For each question, choose either 'yes' or 'no' as your answer.
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Who needs breast questionnaire yes no?
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The breast questionnaire yes/no is needed by individuals who are looking to assess their breast health or have specific concerns about their breasts. It can be used by anyone, including women and men, to track any changes, symptoms, or abnormalities related to their breasts. Healthcare professionals may also use it as a screening tool during routine check-ups or breast examinations.
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What is breast questionnaire yes no?
Breast questionnaire yes no is a survey designed to gather information about an individual's breast health history.
Who is required to file breast questionnaire yes no?
Anyone who has been diagnosed with breast cancer or has a family history of breast cancer may be required to file the questionnaire.
How to fill out breast questionnaire yes no?
The questionnaire can be filled out online or on paper, and requires information about family history, personal health history, and demographic information.
What is the purpose of breast questionnaire yes no?
The purpose of the questionnaire is to gather more information about breast cancer risk factors and help researchers better understand the disease.
What information must be reported on breast questionnaire yes no?
Information about family history of breast cancer, personal health history, and demographic information must be reported on the questionnaire.
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