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PATIENT HEALTH HISTORY Patient name: ___ Preferred name: ___ Date of birth: ___ Age:___ Gender: ___ Height:___ Weight:___ Reason for Appointment:___ Appointment Date: ___ Primary Physician:___ Referring
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How to fill out granite peaks health history

01
Start by obtaining the health history form from Granite Peaks.
02
Fill out all sections accurately and completely, including personal information, medical history, medications, and any allergies.
03
Be sure to include any relevant medical conditions or surgeries you have had in the past.
04
Review the form for accuracy before submitting it to Granite Peaks for review.

Who needs granite peaks health history?

01
Anyone who is a patient at Granite Peaks or is seeking medical treatment there will need to fill out the health history form.
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Granite Peaks Health History is a form that includes information about an individual's medical history, current health status, and any known health issues.
All employees and dependents enrolled in the Granite Peaks Health Plan are required to fill out and submit the health history form annually.
Employees and their dependents can fill out the Granite Peaks Health History form online or manually by providing details about their medical history, current health status, and any known health issues.
The purpose of Granite Peaks Health History is to provide the healthcare provider with important information about an individual's health to ensure proper treatment and care.
Information such as medical history, current health status, known health issues, medications being taken, allergies, and any recent surgeries or hospitalizations must be reported on the Granite Peaks Health History form.
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