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GENERAL INTERVIEW FORM Patient name ___ Date ___ 1. When diagnosed and by whom: ___ 2. Family history: ___ ___ ___ 3. Test completed: ___ Date: ___ Location: ___ 4. Recent weight gain or loss: ___
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Make sure to have the form in front of you.
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Provide accurate and truthful information.
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Who needs health history interview form?

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Individuals seeking medical treatment
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Healthcare providers
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Insurance companies
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The health history interview form is a document that collects information about an individual's medical history, including past illnesses, surgeries, medications, and family history of disease.
The health history interview form is typically required to be completed by patients before seeing a healthcare provider.
To fill out the health history interview form, patients must provide accurate and detailed information about their medical history, including any existing conditions, medications, and family history.
The purpose of the health history interview form is to help healthcare providers better understand a patient's medical background and make more informed decisions about their care.
Information that must be reported on the health history interview form includes details about past illnesses, surgeries, medications, allergies, and family history of disease.
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