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PATIENT TRAVEL QUESTIONNAIRE Dr F Doc rat & Partners Shea Medical Practice St Peters Health Center Sparkenhoe Street Leicester LE2 0TA Tel: 0116 2957835
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How to fill out patient travel questionnaire doc:

01
Start by entering your personal information such as your name, date of birth, and contact details.
02
Provide your travel details including the countries or regions you have visited in the past 30 days and the dates of your travel.
03
Indicate the purpose of your travel, whether it was for leisure, work, or any other reason.
04
Specify the mode of transportation used during your travel, whether it was by air, sea, or land.
05
Mention any layovers or connecting flights you had during your journey.
06
If you have any symptoms or health concerns related to your travel, make sure to describe them in detail.
07
Answer any additional questions regarding your travel history, such as whether you visited any healthcare facilities during your trip.
08
Finally, sign and date the questionnaire to acknowledge the accuracy of the information provided.

Who needs a patient travel questionnaire doc?

01
Individuals who have recently traveled internationally or domestically.
02
Patients who have been in close contact with someone who has traveled.
03
Those who are experiencing symptoms or have health concerns related to their recent travel.
Please note that the specific requirements for filling out a patient travel questionnaire may vary depending on the healthcare facility or organization requesting it.
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Patient travel questionairedoc is a document used to gather information about a patient's recent travel history prior to their medical appointment.
Patients are required to fill out and submit the patient travel questionairedoc before their medical appointment.
Patients must provide accurate information about their recent travel destinations, dates of travel, and any potential exposure to infectious diseases.
The purpose of the patient travel questionairedoc is to assess the potential risk of infectious diseases based on the patient's travel history.
Patients must report details of their recent travel destinations, dates of travel, and any potential exposure to infectious diseases.
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0TA shefamedicalpractice PEGNANT LE2 uk Shefa Docrat Sparkenhoe DOB VACCINATIONS Leicester TYPHOID Tel MENINGITIS TRAVELLER QUESTIONNAIRE POLIO TETANUS HEPATITIS

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