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CARDIOVASCULAR HEALTH QUESTIONNAIRE Today's Date: ___ Name:___Date of Birth: ___Family Physician: ___Smoking History: ___Occupation: ______Drug Allergies: (list medications and symptoms caused): ___
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How to fill out cardiovascular health questionnaire

01
Start by reading and understanding each question on the cardiovascular health questionnaire.
02
Provide accurate and honest answers to each question based on your knowledge of your health history.
03
If you are unsure about any question, seek clarification from a healthcare provider before completing the questionnaire.
04
Double-check your responses to ensure they are filled out completely and correctly.
05
Submit the completed questionnaire to the appropriate healthcare provider or facility.

Who needs cardiovascular health questionnaire?

01
Individuals who are at risk for or have a history of cardiovascular disease.
02
People who are looking to assess their current heart health status.
03
Patients who are undergoing a cardiovascular health screening or evaluation.
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It is a survey that assesses an individual's heart health and risk factors for cardiovascular diseases.
Individuals who are at risk for or have a history of cardiovascular diseases are required to fill out the questionnaire.
The questionnaire can be filled out either online or on paper, providing detailed information about one's medical history, lifestyle habits, and symptoms.
The purpose is to assess an individual's cardiovascular health status, identify potential risks or issues, and create a personalized plan for prevention and management.
Information related to medical history, family history of heart diseases, lifestyle habits, physical activity levels, diet, and any symptoms experienced.
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