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School Based Health Care KU Wichita USD 261 Hayesville PATIENT HISTORY FORM NAME DOB TODAYS DATE Why are you here today? LIST YOUR ILLNESSES, HOSPITALIZATIONS, SURGERIES, AND INJURIES: Date Reason
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01
Open the sbhc-haysville peds health history-fillpdf form in a PDF reader or editor.
02
Begin filling out the form by entering your personal information, such as name, date of birth, and contact details, in the designated fields.
03
Move on to the medical history section and provide accurate information about any existing medical conditions, allergies, medications, or surgeries you have undergone.
04
Answer the specific questions related to your child's health history, if applicable.
05
When completing the immunization section, enter the dates of your child's vaccinations, including the vaccines received and the corresponding doses.
06
Provide any additional information requested, such as emergency contact details or insurance information.
07
Review the filled-out form to ensure all information is accurate and complete.
08
Save the filled-out form for your records or print it for submission, according to the instructions provided by your healthcare provider.

Who needs sbhc-haysville peds health history-fillpdf?

01
Parents or guardians of pediatric patients who need to provide a comprehensive health history for their child to a healthcare provider, specifically the SBHC (School-Based Health Center) in Haysville, may need to fill out the sbhc-haysville peds health history-fillpdf form.
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sbhc-haysville peds health history-fillpdf is a fillable PDF form for recording the health history of pediatric patients at SBHC-Haysville.
Parents or legal guardians of pediatric patients visiting SBHC-Haysville are required to fill out the health history form.
Parents or legal guardians can fill out the sbhc-haysville peds health history-fillpdf by entering the requested information in the fillable fields provided in the PDF form.
The purpose of sbhc-haysville peds health history-fillpdf is to gather important health information about pediatric patients in order to provide better healthcare services at SBHC-Haysville.
The sbhc-haysville peds health history-fillpdf form typically requests information such as medical history, current medications, allergies, immunizations, and any existing health conditions of the pediatric patient.
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