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New Patient Health History Form Gina M. Lehman, DC, FAST Keel L. Farley, DC Lindsay J. Gall, DC 4893 Utica Ridge Rd. #101 Davenport, IA 52807 Tel. (563) 3595600Patient Data First Name:___ MI: ___
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How to fill out gina m
How to fill out gina m
01
Start by providing your personal information such as name, address, date of birth, and contact information.
02
Answer the questions related to your medical history, including any allergies or conditions you may have.
03
Include any information about your family medical history if applicable.
04
Sign and date the form to certify that the information provided is accurate.
Who needs gina m?
01
Individuals who are seeking medical treatment or services.
02
Healthcare providers who need to understand a patient's medical history and allergies.
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What is gina m?
Gina M is a form used to report certain health information under the Genetic Information Nondiscrimination Act (GINA).
Who is required to file gina m?
Employers with 15 or more employees are required to file Gina M if they request genetic information from employees or offer genetic services.
How to fill out gina m?
Gina M can be filled out electronically or on paper. It must include specific health information and be kept confidential.
What is the purpose of gina m?
The purpose of Gina M is to protect individuals from genetic discrimination in the workplace by prohibiting employers from using genetic information for hiring, promotion, or other employment decisions.
What information must be reported on gina m?
Gina M must report any genetic information collected from employees, including family medical history or genetic test results.
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