Medical history taking template

    • [DOC File]King's College London

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      A KCL History Taking format which can be learnt across the school and used in Year 3, 4 and 5. Framework to History Taking. General Procedure. Eliciting a history from a patient is an essential part of being an effective doctor. It: Establishes the doctor-patient relationship. Identifies how the illness has progressed to date. Establishes how the illness has affected the patient and their ...

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    • [DOC File]ExcelSHE » Free Business and Personal Templates, Letters ...

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      Past Medical History: Circle any of the following that you have had. Allergies or Asthma Congestive Heart Failure Hemorrhoids Migraines Alcoholism Depression Hepatitis (Jaundice) Phlebitis Anemia Diabetes High Blood Pressure Psoriasis Arthritis Drug Abuse Heart Blockage Hernia Breast lumps/cysts Eczema-Hives Kidney Stones Stroke Cancer (Tumors) Epilepsy or Seizures Liver Disease Suicide ...

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    • [DOC File]History and Physical Exam Form

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      Past Medical/Surgical History. Condition History Active or Resolved Medication and Supplement List. Medication or Supplement Dosage Why Taking Family Medical History. Medical . Condition Self Parents Grandparents Siblings Other Relatives Alcoholism Anemia Anesthesia problem Arthritis Asthma Autoimmune disorder Bleeding problem Cancer, Breast Cancer, Colon Cancer, Melanoma Cancer, …

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    • [DOCX File]Medical History - National Institutes of Health

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      Studies that need to collect Start Time will need to add fields for time to the form template. Stop Date and Time –Record the date (and time if applicable to the study) the participant/subject stopped . taking the medication. The date/time should be recorded to the level of granularity known (e.g., year, year . and month, complete date plus hours and minutes, etc.) and in the format ...

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    • [DOCX File]Delegation of Duties Log Template

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      PRIOR TO TAKING PART IN ANY STUDY ACTIVITIES. DIVISION OF AIDS (DAIDS) DELEGATION OF DUTIES LOG. TEMPLATE. Principal . Investigator (PI) /Investigator of Record (IoR) By signing, I confirm/acknowledge that the tasks listed below will only be delegated to appropriately trained, skilled, and qualified staff. I remain responsible for the overall study conduct and reported data and I will …

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    • [DOCX File]NIDCR Clinical Study Observational Protocol

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      Medical history (describe what is included for history, e.g., time-frame considerations, whether history will be obtained by interview or from medical records). Medications history (describe if a complete medications history is needed, or if only currently taken medications should be included; prescription medications only or also over-the-counter).

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    • [DOC File]Best Possible Medication History form

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      Patient is not taking any non-prescription or natural health products at this time. ( (Check box or give product details below) WHAT I TAKE. Name, strength & form of medication as noted on the prescription or medication package label WHY I TAKE IT. Disease, condition or symptoms it addresses HOW I TAKE IT. For example, when to take it, take with/without food, warnings, etc. SPECIAL ...

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    • [DOC File]EMDR Training for Therapists, Counsellors, Psychologists ...

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      PHASE 1 HISTORY TAKING. CLIENT SAFETY FACTORS CHECKLIST. Rate each item beneath for the level of risk or concern you have: 0 (No risk/concern) to 5 (High risk/concern) (NB: This checklist is meant a guide, however, it cannot cover all the information you may require for all client groups).

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    • [DOC File]PATIENT HISTORY FORM - Hopkins Medicine

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      Title: PATIENT HISTORY FORM Author: abaer5 Last modified by: Elaine Martin Created Date: 7/8/2008 5:55:00 PM Company: JHU DOM Other titles: PATIENT HISTORY FORM

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