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Wells Atlanta LLC 11755 Point Place Suite A, Roswell, Georgia 30076 Telephone: (770) 7539898 Website: www.WellStep.comPatient Intake: Medical History (To be completed by patient)Use the opposite side
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Start by reading the form carefully to understand the information required.
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Gather all necessary medical documents and records that might be needed.
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Begin filling out the form by providing personal information such as name, contact details, and date of birth.
05
Answer the questions regarding your past medical history. Include any diagnosed conditions, surgeries, allergies, or medications you are currently taking.
06
Provide information about your family medical history, including any hereditary diseases or conditions among close relatives.
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If applicable, answer questions regarding your lifestyle habits such as smoking, alcohol consumption, or exercise routine.
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Carefully review the form and ensure all the information provided is accurate and up-to-date.
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Sign and date the form to indicate your consent and agreement with the information provided.
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Submit the completed form to the relevant healthcare provider or institution.
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The medical-history-formdoc is typically required by individuals who are seeking medical treatment or consultations. It is important for both new patients and existing patients to fill out this form as it helps healthcare professionals better understand their medical background and make appropriate treatment decisions.
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Medical-history-formdoc is a document used to collect an individual's medical history for healthcare purposes, such as diagnosis, treatment planning, and insurance requirements.
Individuals seeking medical care, health insurance, or participating in clinical trials are typically required to file a medical-history-formdoc.
To fill out medical-history-formdoc, individuals should provide accurate and comprehensive information about their medical history, including past illnesses, surgeries, medications, allergies, and family medical history.
The purpose of medical-history-formdoc is to gather essential information that aids healthcare providers in making informed decisions about a patient's care and treatment.
Information that must be reported includes personal identification details, medical conditions, previous treatments, surgeries, allergies, medications currently taken, and family medical history.
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