List of all surgeries

• [DOC File]Microsoft Word - patient_information.doc

  https://info.5y1.org/list-of-all-surgeries_1_05bb8a.html

  Please list all previous trauma / auto accidents / surgeries & hospitalizations with dates and treatment: Please list all current medications / dietary supplements / all routine exercise & physical activities: Do you have Hepatitis B / Hepatitis C / Tuberculosis or HIV infection (Circle any that apply)

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• [DOCX File]Childrens Surgical Associates – Pediatric Surgeon Atlanta

  https://info.5y1.org/list-of-all-surgeries_1_14b0a3.html

  List all medications your CHILD is ALLERGIC to: _____ PAST MEDICAL HISTORY. List all surgeries your child has had, when, and where: _____ List all hospitalizations other than for surgery indications why, when, and where: _____ ...

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• [DOC File]THE RETINA GROUP - MEDICAL HISTORY QUESTIONAIRE

  https://info.5y1.org/list-of-all-surgeries_1_e9c004.html

  List all OTHER surgeries and hospitalizations with dates: List all Medications or provide list Please list all medication ALLERGIC REACTIONS or sensitivities & reaction to the drug

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• [DOC File]CURRENT MEDICAL HISTORY - Drayer Orthopedics

  https://info.5y1.org/list-of-all-surgeries_1_597d91.html

  List ALL prior hospitalizations/surgeries (approximate date and not limited to orthopedic injuries or current injury/ailment). List ALL prior surgeries (even unrelated to current complaint): Family History: Heart Disease Diabetes High blood pressure Stroke. DVT / blood clot Lung disease Other: Social History: Substance Abuse ...

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• [DOC File]Nephrology Associates of Syracuse, PC | Kidney Doctors

  https://info.5y1.org/list-of-all-surgeries_1_7915d2.html

  Date_____ List all surgeries with dates Patient History Form _____ Name _____ _____ Date of Birth_____ Age _____ _____

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• [DOC File]MACHESTER FAMILY HEALTH

  https://info.5y1.org/list-of-all-surgeries_1_e8f733.html

  Please list all surgeries you have had and the approximate year: _____ SEVERE INJURIES . Please list dates and details of any injuries you have ever had _____ _____ IMMUNIZATIONS . Date of TB screening? _____ POS NEG . Date of last Tetanus vaccine?

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• [DOC File]CIVIL AIR PATROL

  https://info.5y1.org/list-of-all-surgeries_1_a7773b.html

  (List any dietary restrictions like food allergies, diabetes, gluten-free, vegetarian diets, etc.) Past Surgical History (List all surgeries including tonsils, ear tubes, appendix, gall bladder, hernia, hysterectomy, heart, heart catheterization, bone and joint and all other surgeries.)

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• [DOC File]NEPHROLOGY ASSOCIATES OF NORTHEAST FLORIDA PATIENT HISTORY ...

  https://info.5y1.org/list-of-all-surgeries_1_ffc12e.html

  IV. PLEASE LIST MEDICINES INCLUDING OVER THE COUNTER AND HERBALS AND/OR BRING TO CLINIC VISIT: Medication with dose and frequency per day Medication with dose and frequency per day 1. 8. 2. 9. 3. 10. 4. 11. 5. 12. 6. 13. 7. 14. V. LIST ALL SURGERIES: SURGEON: APPROXIMATE DATE:

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• [DOC File]1 of 3

  https://info.5y1.org/list-of-all-surgeries_1_29792f.html

  List the names of any Physicians you have seen in the last six (6) months: List all surgeries and the year of each surgery: **Would you accept Blood or Blood Products in the event of an emergency to potentially save your life?**

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• [DOC File]WILLIAMS FOOT CENTER

  https://info.5y1.org/list-of-all-surgeries_1_277f8b.html

  Please list ALL surgeries with dates: ... List ALL medications you currently take: Name Dosage How Often # per day Used for ...

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• [DOC File]Check List for ASC’s

  https://info.5y1.org/list-of-all-surgeries_1_1bb6cd.html

  The list should include each. patient’s name, age, type of surgical procedure, etc. ___ Average monthly volume of surgeries performed. ___ A list of all surgeries from the past six months and all patient deaths in the past 12 months. ___ A copy of the facility’s organizational chart. ___ A list of all contracted or arranged services.

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• [DOCX File]Orthopaedic Doctors in Rochester NY | Orthopaedics ...

  https://info.5y1.org/list-of-all-surgeries_1_0ab539.html

  List Medical Problems You Have or Had: List All Medications You Take List Surgeries You Have Had List Allergies to Medications Can you take Anti-inflammatory Drugs (Ibuprofen, Aleve, Aspirin)?

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• [DOC File]SURGERIES/PROCEDURES RECOMMENDED FOR PREAUTH REVIEW

  https://info.5y1.org/list-of-all-surgeries_1_b1edcd.html

  All children 16 and under – evaluation only for PT/OT/ST. No additional sessions until approved by Aurora Medical Management. (CPT 97001 - 97546, and 92506 - 92508). All speech therapy – evaluation only. No additional sessions until approved by Aurora Medical Management. (CPT 92506-92508). All Outpatient Cardiac Rehab (CPT 93797-93798).

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• [DOC File]New Patient Information Form

  https://info.5y1.org/list-of-all-surgeries_1_df9b70.html

  Please list all surgeries you have had in the past. List any complications (bleeding, infection, blood clots, etc) *Review of Symptoms and Past Medical History Do you have or had any of the following Problems?

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