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Nicole Schrader, M.D., F.A.C.S. Schrader Plastic Surgery256 Bunn Drive, Suite A, Princeton NJ 08540 Phone: (609) 2790009 Fax: (609) 4543301Health History Sheet Name (Please Print):___ Presenting problem
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How to fill out health history sheet
How to fill out health history sheet
01
Start with personal information: Include your name, date of birth, and contact information.
02
Provide insurance details: List your insurance provider and policy number if applicable.
03
Fill in medical history: Document any past surgeries, hospitalizations, or significant health conditions.
04
List current medications: Include prescription and over-the-counter medications you are currently taking.
05
Detail allergies: Note any known allergies to medications, foods, or environmental factors.
06
Mention family medical history: Include any hereditary health issues from immediate family members.
07
Review lifestyle factors: Describe your exercise routine, dietary habits, and substance use such as smoking or alcohol.
08
Sign and date the form: Ensure the sheet is signed to verify the accuracy of the provided information.
Who needs health history sheet?
01
Individuals seeking medical care or health services.
02
Patients visiting a new healthcare provider for the first time.
03
People participating in research studies or clinical trials.
04
Those applying for life or health insurance.
05
Athletes or participants in physical activities requiring health assessments.
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What is health history sheet?
A health history sheet is a document that collects information about an individual's medical history, including past illnesses, surgeries, allergies, and current medications.
Who is required to file health history sheet?
Individuals seeking certain medical services or insurance coverage are typically required to file a health history sheet.
How to fill out health history sheet?
To fill out a health history sheet, provide accurate and complete information about your medical history, including any relevant health conditions, treatments, and medications.
What is the purpose of health history sheet?
The purpose of a health history sheet is to inform healthcare providers about a patient's medical background to ensure safe and appropriate care.
What information must be reported on health history sheet?
Information that must be reported includes personal identification details, medical conditions, previous surgeries, allergies, family health history, and current medications.
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