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Duke Student Health Allergy Clinic (DS HAC) DUMP Box 2899 Duke University Medical Center Durham, NC 27710 Telephone 919-681-2465 Fax 919-681-5384 REQUEST FOR ALLERGY IMMUNOTHERAPY INITIATED BY NON-STUDENT

How to fill out request for allergy immunoformrapy

How to fill out a request for allergy immunotherapy:

1. Start by filling out your personal information on the form. This includes your name, date of birth, contact information, and any relevant identification numbers.
2. Provide details about your medical history. Indicate any previous allergies you have experienced, as well as any medications or treatments you have tried in the past. This will help the healthcare provider understand your specific needs.
3. Describe your current symptoms and their severity. Be as specific as possible about the reactions you experience when exposed to allergens. This will help the healthcare provider determine the appropriate immunotherapy for your condition.
4. Include information about any previous immunotherapy treatments you may have received. If you have undergone any allergy shots or other forms of immunotherapy in the past, provide details about the duration and effectiveness of the treatment.
5. Express your goals and expectations for allergy immunotherapy. Describe any specific outcomes you hope to achieve, such as a reduction in symptoms or an improvement in your overall quality of life.

Who needs a request for allergy immunotherapy?

1. Individuals who suffer from allergies, such as hay fever, allergic rhinitis, or allergic asthma, may need to request allergy immunotherapy. These individuals often experience recurring or severe allergic reactions that significantly impact their daily lives.
2. People who have tried other allergy treatments with limited success may benefit from requesting allergy immunotherapy. This form of treatment aims to desensitize the body to specific allergens, thereby reducing the frequency and severity of allergic reactions.
3. Patients who have been diagnosed with specific allergens through allergy testing may be eligible for immunotherapy. By identifying the substances to which you are allergic, healthcare providers can tailor the immunotherapy treatment to your specific needs.

In summary, filling out a request for allergy immunotherapy requires providing personal information, detailing your medical history and current symptoms, including any previous immunotherapy treatments, and expressing your goals for treatment. Allergy immunotherapy may be beneficial for individuals suffering from allergies, who have not found relief with other treatments, and have been diagnosed with specific allergens through testing.

For pdfFiller’s FAQs

What is request for allergy immunotherapy?

Request for allergy immunotherapy is a formal document submitted to a healthcare provider requesting treatment for allergies through immunotherapy.

Who is required to file request for allergy immunotherapy?

Patients who are seeking allergy treatment through immunotherapy are required to file the request.

How to fill out request for allergy immunotherapy?

To fill out a request for allergy immunotherapy, patients need to provide their medical history, allergy symptoms, and any previous treatments.

What is the purpose of request for allergy immunotherapy?

The purpose of request for allergy immunotherapy is to initiate a specialized treatment plan to help patients reduce their allergic reactions.

What information must be reported on request for allergy immunotherapy?

Information such as medical history, allergy triggers, symptoms, and previous treatments must be reported on the request.

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