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Breast Cervical & Colon Health Program 401 5th Ave #1110 Seattle WA 98104T 2062638176 F 2062960208 DOH 342058 Feb 2018COLON HISTORY & SCREENING FORM BC CHP ID#Please Print Name:First Name: Clinic/Screening
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How to fill out colon history amp screening

01
To fill out a colon history and screening form, follow these steps:
02
Gather all relevant medical records and information related to your colon health.
03
Start by providing your basic personal details such as name, date of birth, and contact information.
04
Answer specific questions about your medical history, including any previous colon surgeries, medications, or known colon-related conditions.
05
Provide details about your family's medical history, especially if there is a history of colon cancer or other related diseases.
06
Answer questions about your lifestyle and dietary habits, as these factors can impact colon health.
07
If applicable, provide information about any previous colon screenings you have undergone.
08
Review your responses carefully to ensure accuracy and completeness.
09
Sign and date the form to authenticate your responses.
10
Submit the filled-out form to the designated healthcare provider or facility as instructed.

Who needs colon history amp screening?

01
Colon history and screening is recommended for individuals who:
02
- Are above the age of 50, as the risk of developing colon cancer increases with age.
03
- Have a family history of colon cancer or certain genetic conditions that predispose them to colon-related diseases.
04
- Have previously had colon polyps or other abnormalities detected during a previous colonoscopy or screening.
05
- Have experienced symptoms or warning signs of colon problems, such as rectal bleeding, persistent abdominal pain, or unexplained weight loss.
06
- Have certain medical conditions that increase the risk of colon cancer, such as inflammatory bowel disease.
07
- Are advised by their healthcare provider to undergo routine colon screening based on individual risk factors and health history.
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Colon history & screening refers to the assessment and tests performed to detect potential issues in the colon, including colorectal cancer. It involves evaluating personal and family medical history, and may include procedures like colonoscopy.
Individuals aged 45 and older, or those with a family history of colorectal issues, are typically required to file colon history & screening documentation, often as part of routine health care requirements.
To fill out colon history & screening, individuals must provide details about their medical history, any symptoms, family history of colorectal diseases, and past screening results. Specific forms from healthcare providers should be completed accurately.
The purpose of colon history & screening is to identify risks for colorectal cancer and other gastrointestinal conditions, enabling early intervention and treatment which can significantly improve health outcomes.
Information that must be reported includes personal medical history, family medical history related to colorectal issues, any previous screening results, and relevant symptoms experienced.
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