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Desert Peaks Health Care Health History Questionnaire Patient Name (printed):___ Date of Birth:___ Reason for Visit: ___ Past Medical History: (check all that apply) Anxiety Asthma Depression COPD/emphysema
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Desert Peaks Healthcare is a healthcare provider located in the desert region.
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Healthcare providers and organizations are required to file Desert Peaks Health Care forms.
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The purpose of Desert Peaks Health Care form is to report healthcare data and information to the relevant authorities.
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Information such as patient demographics, medical history, treatments provided, and billing information must be reported on Desert Peaks Health Care form.
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