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Pain Management New Patient Intake Patient Name: ___DOB: ___Reason for Visit: ___ Were you referred to our office? Yes|Noises, by whom? ___Location of Pain: ___ Date of Onset: ___ Circle all that
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Start by gathering all necessary information such as personal details, medical history, current medications, and any allergies.
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Fill out the patient's demographic information including name, date of birth, address, and contact information.
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List all current medications being taken by the patient including dosage and frequency.
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The h&p center refers to the Health & Physical Center, a facility for health and physical activities.
Students and faculty members who use the Health & Physical Center are required to file certain documentation.
To fill out the h&p center forms, individuals need to provide personal and health information as requested.
The purpose of the h&p center is to ensure that individuals are healthy and fit to use the facilities.
Information such as medical history, current health conditions, and emergency contact details must be reported on the h&p center forms.
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