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Dr Andrei Proud ND, RAC TEEN form (1016 years old) Welcome to your initial naturopathic consultation. Please take the time to fill out this form in order to give me background information needed to
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Start by entering the patient's personal information, such as their name, date of birth, and contact details.
02
Move on to gathering the patient's medical history, including any past illnesses, surgeries, or medical conditions they have experienced.
03
Ask about the patient's current medications, allergies, and any ongoing treatments they might be undergoing.
04
Inquire about the patient's family medical history, including any hereditary diseases or conditions that run in the family.
05
Document the patient's lifestyle habits, such as smoking, alcohol consumption, and exercise routine.
06
Ask the patient about their current symptoms, the duration of these symptoms, and any triggers that exacerbate their condition.
07
Collect information about the patient's insurance coverage and emergency contact details.
08
Finally, review the completed form with the patient to ensure all information is accurate and complete.

Who needs patient intake form -teen?

01
Teenagers who are visiting a healthcare facility for the first time or are starting a new treatment.
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The patient intake form -teen is a document designed for teenage patients to collect essential health information during their first visit to a healthcare facility.
The patient intake form -teen is required to be filled out by teenage patients or their guardians when seeking healthcare services.
To fill out the patient intake form -teen, provide accurate personal information, medical history, any ongoing medications, allergies, and relevant family health history.
The purpose of the patient intake form -teen is to gather necessary health information that assists healthcare providers in understanding the patient's medical needs and ensuring proper care.
The information that must be reported includes the patient's name, date of birth, contact information, medical history, allergies, medications, and family medical history.
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