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Hindsight Thermographic Clinic 25 Flume Dr. Middle Vacaville, NS B4E3H1BREAST HEALTH HISTORY Name: Age: Date of Birth: Address: City: Postal Code Home Tel: Work Tel: Email Occupation: Marital Status:

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How to fill out breast health history

01

Step 1: Start by gathering information about your medical history including previous diagnoses and treatments related to breast health.

02

Step 2: Fill out personal information such as your name, date of birth, contact information, and primary care physician.

03

Step 3: Provide details about any family history of breast cancer or other breast conditions in your immediate family.

04

Step 4: Include information about your reproductive history, such as pregnancies, breastfeeding, and menopause status.

05

Step 5: Note any previous breast surgeries or biopsies, and provide details about the results and any follow-up care.

06

Step 6: Fill out information about lifestyle factors that may impact breast health, such as alcohol consumption, smoking habits, and exercise routine.

07

Step 7: Review the completed form for accuracy and make sure all sections are filled out.

08

Step 8: Submit the filled-out breast health history form to your healthcare provider for further evaluation.

Who needs breast health history?

01

Anyone who seeks medical care related to breast health should fill out a breast health history form. This may include individuals with a personal history of breast conditions, a family history of breast cancer or other related conditions, or those who want to monitor and maintain their breast health. It is also recommended for individuals undergoing regular breast screenings or seeking preventive measures.

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What is breast health history?

Breast health history is a comprehensive record of an individual's breast health, including any previous conditions, surgeries, and screenings related to breast health.

Who is required to file breast health history?

Individuals seeking medical care related to breast health, healthcare providers, and certain organizations may be required to file breast health history as part of patient records or compliance requirements.

How to fill out breast health history?

To fill out breast health history, individuals should provide detailed information about their personal and family medical history, previous breast conditions, surgeries, mammograms, and any other relevant health data.

What is the purpose of breast health history?

The purpose of breast health history is to inform healthcare providers of any existing or past breast health issues, enabling them to provide personalized care and recommend appropriate screenings or treatments.

What information must be reported on breast health history?

Information that must be reported includes personal and family medical history, any prior breast-related diagnoses, treatment history, results from previous mammograms, and any noticeable changes in breast health.

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