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Westside Gastroenterology
Associates
Date:Name:adult HISTORY REVIEWBirthdate:(last, first, middle)
Occupation:FAMILY HISTORYRelationAgeIf deceased,
cause of
devastate of Healthcare at
death Father:
Mother:
Brother/Sister:Spouse:
Children:Indicate
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What is adult history reviewxls?
Adult history reviewxls is a form used to collect information about an individual's medical history, past surgeries, allergies, medications, etc.
Who is required to file adult history reviewxls?
Adults who are seeking medical treatment or undergoing a medical procedure are required to fill out the adult history reviewxls.
How to fill out adult history reviewxls?
Adults can fill out the adult history reviewxls by providing accurate and detailed information about their medical history, past surgeries, allergies, medications, etc.
What is the purpose of adult history reviewxls?
The purpose of adult history reviewxls is to allow healthcare providers to have a comprehensive understanding of an individual's medical history in order to provide the best possible care.
What information must be reported on adult history reviewxls?
Information such as medical history, past surgeries, allergies, medications, current health conditions, and family medical history must be reported on the adult history reviewxls.
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