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Lolien Medical Aesthetics and Wellness Dr Gomal Khan MD New Patient formulate / /Name First ___ Last ___DOB ___ Age ___Occupation ___Address ___City ___State ___ Zip ___Phone (H) ___ (C) ___ (please
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Start by gathering all relevant medical documents and information.
02
Use a pen to circle the appropriate answers on the medical history form.
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Fill out each section carefully and accurately, providing detailed information where necessary.
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Make sure to include details about any pre-existing conditions, allergies, medications, and surgeries.
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Medical history refers to a record of a patient's past health issues, treatments, medications, and significant family and lifestyle factors that may affect their health.
Individuals seeking medical care, patients undergoing surgery or treatment, and those applying for health insurance are required to file a medical history.
To fill out medical history, individuals should provide accurate and detailed information about their past medical conditions, surgeries, medications, and lifestyle habits on the designated form.
The purpose of medical history is to assist healthcare providers in understanding a patient's health background to make informed decisions about diagnosis and treatment.
Information that must be reported includes past illnesses, surgeries, allergies, current medications, family health history, and lifestyle factors such as smoking and alcohol use.
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