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Center for Integral Health INFORMATION FOR YOUR PHYSICIAN Name: Address: StreetHome Phone: ( ) Marital Status: S M D W Present Marriage: (yr. married) Occupation: Education: (Highest Level Attained)Referred
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To fill out the CIH Adult History Form, follow these steps:
02
Start by entering your personal information. This includes your full name, date of birth, and contact details.
03
Next, provide details about your medical history. Mention any pre-existing conditions, allergies, or medications you are currently taking.
04
Fill in information about your family medical history. Include any hereditary or genetic conditions that run in your family.
05
Provide details about your lifestyle and habits. This may include information about your diet, exercise routine, and substance use.
06
Answer questions about your mental health. Mention any history of depression, anxiety, or other mental health disorders.
07
Finally, review the form for accuracy and completeness before submitting it.

Who needs cih adult history form?

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The CIH Adult History Form is required for individuals seeking medical care or treatment. It is typically needed by healthcare providers, doctors, or specialists to assess a patient's medical history and make informed decisions regarding their healthcare.
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The CIH Adult History Form is a required document that collects historical information about an individual's criminal background, substance use, and other relevant personal history, typically for assessments by certain organizations.
Individuals applying for certain positions or licenses, particularly those in the fields of education, healthcare, or positions involving vulnerable populations, are required to file the CIH Adult History Form.
To fill out the CIH Adult History Form, individuals should carefully complete all sections as instructed, providing accurate personal information, answering all questions regarding criminal history and other required disclosures, and ensuring to double-check for completeness before submission.
The purpose of the CIH Adult History Form is to assess an individual's suitability for employment or licensure by evaluating their past behavior, criminal records, and potential risks to others.
The CIH Adult History Form typically requires reporting of personal identification information, details regarding any criminal convictions, instances of substance abuse, and any other relevant historical data that pertain to the individual's background.
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