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Valley Vision Associates Robert Davis O.D. Erick Johnson O.D. Abel Li M.D. Scott Altman O.D. PATIENT HISTORY QUESTIONNAIRE IMPORTANT: This questionnaire is to be reviewed at each appointment. Please
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01
Begin by gathering all necessary information such as personal details, medical history, and current medications.
02
Start filling out the form by entering your personal information including name, date of birth, and contact details.
03
Proceed to the medical history section and provide accurate details for any previous or existing medical conditions you have been diagnosed with.
04
Include information about any surgeries or hospitalizations you have undergone in the past, along with the dates and reasons for these procedures.
05
List all current medications you are taking, including the dosage and frequency of each.
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Answer any additional questions related to your medical history, such as allergies or family medical history.
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Double-check all the information you have entered to ensure it is accurate and complete.
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Finally, sign and date the form to certify that the information provided is true and accurate.
Who needs health history2016 reviseddoc?
01
Anyone seeking medical care or undergoing a medical evaluation is typically required to fill out the Health History 2016 Revised Document.
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What is health history2016 reviseddoc?
Health history2016 reviseddoc is a document used to collect and record an individual's health history for medical purposes, ensuring accurate medical treatment and care.
Who is required to file health history2016 reviseddoc?
Individuals seeking medical treatment, health insurance, or participation in specific health programs are typically required to file the health history2016 reviseddoc.
How to fill out health history2016 reviseddoc?
To fill out health history2016 reviseddoc, individuals should provide accurate personal information, complete medical history, and any relevant data concerning past illnesses, surgeries, medications, and allergies.
What is the purpose of health history2016 reviseddoc?
The purpose of health history2016 reviseddoc is to gather comprehensive health information that aids healthcare providers in making informed decisions about diagnosis, treatment, and preventative care.
What information must be reported on health history2016 reviseddoc?
Required information includes personal identification details, medical conditions, treatment history, family health history, allergies, medications, and lifestyle factors.
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