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APA Vintage Division Medical History & Physical Exam Form Name: Address: Birth Date: / / In the event of Emergency Contact: 1. Name: Phone #: () 2. Name: Any vehicle mishaps in previous year? Response
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How to fill out history and physical form
How to fill out history and physical form
01
To fill out a history and physical form, follow these steps:
02
Start by filling out your personal information, including your name, date of birth, address, and contact information.
03
Next, provide your medical history, including any past surgeries, illnesses, or chronic conditions you have experienced.
04
Include any current medications you are taking, including dosages and frequency.
05
Provide details about your family medical history, such as any hereditary conditions or diseases that run in your family.
06
Answer questions about your lifestyle habits, including exercise routine, diet, smoking or alcohol consumption.
07
Describe any allergies or adverse reactions you have experienced to medications or other substances.
08
Finally, sign and date the form to indicate that the information provided is accurate and complete.
Who needs history and physical form?
01
History and physical forms are typically required for new patients visiting a healthcare provider for the first time.
02
They are also commonly used for pre-employment physicals, sports participation, and before undergoing certain medical procedures.
03
Additionally, health insurance companies may require a history and physical form to determine coverage and eligibility.
04
Overall, anyone seeking medical care or undergoing a health assessment may need to fill out a history and physical form.
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