Major Health Awareness Days in 2016
|
|
- Crystal Haynes
- 6 years ago
- Views:
Transcription
1 Major Health Awareness Days in 2016 Whole year International Year of Pulses January All summer Big Red BBQ (Kidney Foundation) National Cervical Health Awareness Month February Ovarian Cancer Awareness Month FebFast Heart Research Month FebruDAREy (Cerebral Palsy) 4 February World Cancer Day 6 February Play Outside Day February Australia s Healthy Weight Week 18 February International Asperger's Day 24 February Business Clean Up Australia Day 24 February Teal Ribbon Day (ovarian cancer) 26 February Wear Red Day (Heart Research) 28 February Rare Diseases Day March National Epilepsy Awareness Month March Into Yellow (Endometriosis) Melanoma March Jump to Cure Diabetes 29 Feb-6 March World Salt Awareness Week 1 March World Compliment Day 1 March Clean Up Australia Day 4-10 March National Sleep Awareness Week 6 March Lymphoedema Awareness Day 6-12 March World Glaucoma Week 8 March International Women s Day 10 March World Kidney Day
2 10-13 March World s Greatest Shave (Leukemia) March Coeliac Awareness Week March International Brain Awareness Week 18 March National Day of Action against Bullying and Violence 20 March International Day of Happiness 20 March World Oral Health Day 21 March World Down Syndrome Day March National Wound Awareness Week March Meat Free Week 22 March World Water Day 26 March Purple Day for epilepsy April Supermarket Free Month Go Blue for Autism 1 April National Smile Day 1-10 April International Seniors Week 2 April World Autism Day 2-16 April Variety Cycle 3 April Be Alarmed change your smoke alarm battery 7 April World Health Day 11 April World Parkinson's Day April World Creativity & Innovation Week 17 April World Haemophilia Day 22 April World Mother Earth Day April National Carbon Monoxide Awareness Week April World Immunisation Week 25 April DNA Day 28 April World Day for Safety and Health at Work 28 April Pay It Forward Day 29 April International Dance Day May Mindful in May 65 Roses (Cystic Fibrosis) Crohns and Colitis Awareness Month Thyroid Awareness Month Kiss Goodbye to MS Eczema Awareness Month 1 May-30 June Australia s Biggest Morning Tea (Cancer) 1 May White Shirt Day (Ovarian Cancer Research) 1-7 May National Heart Week
3 1-7 May Tourette Syndrome Awareness Week 3 May World Asthma Day 4-10 May UN Global Road Safety Week 5 May World Hand Hygiene Day 6 May International No Diet Day 8 May World Ovarian Cancer Day 8 May World Red Cross Day 9-15 May National Volunteer Week 10 May World Lupus Day 12 May International Awareness Day (Chronic Immunological and Neurological Diseases (CIND) May Coeliac Awareness Week May Food Allergy Awareness Week 15 May International Day of Families 17 May World Hypertension Day 19 May World IBD Day (Crohns and Colitis) 20 May World Autoimmune Arthritis Day May Macular Degeneration Awareness Week May Kidney Health Week May Exercise Right Week 25 May World Thyroid Day May Spinal Health Week 29 May Wear White at Work Day (suicide & mental illness) 31 May World No Tobacco Day June Bowel Cancer Awareness Month 8 June World Brain Tumour Day June National Blood Donor Week June Men s Health Week 15 June Red Apple Day (bowel cancer) July Dry July JulEYE - Eye Health Awareness Month 4-10 July Sleep Awareness Week July National Diabetes Week July National Farm Safety Week 24 July Stress Down Day July National Pain Week 28 July World Hepatitis Day 28 July-5 August OCD and Anxiety Disorders Week 30 July-7 August DonateLife Week
4 August Tradies National Health Month 1-7 August World Breastfeeding Week 1-7 August National Healthy Bones Week 1-8 August Dental Health Week 5 August Jeans for Genes Day 8 August Dying to Know Day (D2KD) (dying & bereavement( 13 August Left Handers Day August (TBC) Brain Injury Awareness Week August Hearing Awareness Week 28 August Daffodil Day (Cancer Council) September Blue September (men s cancers) International Prostate Cancer Awareness Month 1 September Gold Bow Day 5-9 September Women s Health Week 8 September World Physiotherapy Day 8 September R U OK? Day September National Stroke Week 10 September World Suicide Prevention Day 13 September World First Aid Day 15 September World Lymphoma Awareness Day September Headache and Migraine Week 21 September World Alzheimer's Day 21 September World Gratitude Day 22 September World Car-free Day 29 September World Heart Day October National Safe Work Australia Month Mental Health Month Ocsober (give up alcohol) Droptober (obesity) Breast Cancer Awareness Month Walktober Lupus Awareness Month Shoctober (Defibrillator Awareness) 1 October World Vegetarian Day 3 October Virus Appreciation Day 9-15 October Mental Health Week 10 October World Mental Health Day
5 12 October International Arthritis Day 12 October Ride to Work Day October (TBC) Be Medicine-Wise Week 13 October World Sight Day 15 October Global Handwashing Day October National Nutrition Week October Carers Week 20 October World Osteoporosis Day 22 October International Stuttering Awareness Day October Sock-It-To-Suicide Week October International Lead Poisoning Prevention Week of Action October International Brain Tumour Awareness Week 24 October Pink Ribbon Day November Movember: Changing the Face of Men s Health Lung Health Awareness Month 6-12 November Australian Food Safety Week 12 November World Pneumonia Day November Perinatal Depression and Anxiety Awareness Week November National Skin Cancer Action Week 14 November World Diabetes Day November Antibiotic Awareness Week 16 November World Chronic Obstructive Pulmonary Disease (COPD) Day December Decembeard (bowel cancer) 1 December World AIDS Day 3 December International Day of People with Disability (IDPwD) 5 December International Volunteer Day
January Intravenous Nurse Day ALL MONTH LONG SUN MON TUE WED THU FRI SAT. Blood Donor Month. Glaucoma Awareness Month
January 1 2 3 4 5 6 Blood Donor Month 7 8 9 10 11 12 13 Glaucoma Awareness Month Volunteer Blood Donor Month Cervical Health Awareness Month 14 15 16 17 18 19 20 Thyroid Awareness Month Birth Defects Prevention
More information2016 Health and Wellness Observances
2016 Health and Wellness Observances January 2016 Notes HealthCom Cervical Health Awareness Month National Birth Defects Prevention Month Cervical Cancer Screening Month National Blood Donor Month National
More informationCITY OF BEVERLY HILLS. Office of Emergency Management MEMORANDUM
CITY OF BEVERLY HILLS Office of Emergency Management MEMORANDUM TO: FROM: Health and Safety Commission Pamela Mottice Muller, Director DATE: July 25, 2016 SUBJECT: Health and Safety Observances Commemorative
More information2017 Health and Wellness Calendar
Healthy Highways 207 Health and Wellness Calendar www.exclusivecare/healhtyhighways.com January 207 January is: Cervical Health Awareness National Birth Defects Prevention National Glaucoma Awareness Thyroid
More information2018 Cause Awareness Day Calendar
2018 Cause Awareness Day Calendar January Alzheimer s Disease Awareness Month Cervical Health Awareness Month Dry January National Blood Donor Month National Glaucoma Awareness Month Thyroid Awareness
More informationDOCTOR MECHANIC POLITICIAN FOOTBALLER PILOT TRAIN DRIVER GARDENER FAMOUS PERSON FIRE FIGHTER RACING CAR DRIVER MAYOR COUNCIL WORKER TRUCK DRIVER
DOCTOR MECHANIC FOOTBALLER POLITICIAN PILOT TRAIN DRIVER GARDENER FAMOUS PERSON FIRE FIGHTER RACING CAR DRIVER MAYOR CHEF COUNCIL WORKER TRUCK DRIVER January 2012 SUN MON TUE WED THU FRI SAT 1 New Years
More informationSCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs. January 2018 WALK INS ARE ACCEPTED BUT WE ADVISE STUDENTS TO PRE-REGISTER BEFORE THURSDAY
SCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs January 201 DATE DAY TIME TOPICS January 04 January 11 January 1 January 25 9:00AM 9:00AM 9:00AM 9:00AM 1. Understanding Fibromyalagia 2. Diabetes
More informationSCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs. January 2018
January 201 DATE DAY TIME TOPICS TOTAL January 04 1. Understanding Fibromyalagia 2. Diabetes and Cardiovascular Disease 3. Prostate Cancer 4. Hepatitis C 5. Understanding Hepatitis B January 11 1. Dysphagia
More informationSCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs. January 2019
January 2019 DATE DAY TIME TOPICS TOTAL January 03 1. Alcoholism 2. Nutrition for the Elderly 3. Uterine Fibroids 4. HIPAA 5.Arthritis 6. Childhood Obesity January 10 1. Understanding Epilepsy: Latest
More informationA News Canada Company EDITORIAL CALENDAR JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC
A News Canada Company EDITORIAL CALENDAR JANUARY JANUARY JANUARY JANUARY Cold & Flu Prevention Financial Information Gift Registry New Year s Resolutions RRSP Information Weight Loss Alzheimer Awareness
More informationHow much do you know about illnesses or health problems for your parents, grandparents, brothers, sisters, and/or children? 1 A lot Some None at all
Family Health History Please answer each question as honestly as possible. There are no right or wrong answers to nay of the questions. It is important that you answer as many questions as you can. We
More informationBig List of Charitable Causes and Design Ideas
Big List of Charitable Causes and Design Ideas Clickable Table of Contents Causes beneath each category are listed in alphabetical order. Just click the cause you re most interested to jump there directly.
More information2018 Health Awareness Calendar
2018 Health Awareness Calendar January SunSmart Skin Cancer Awareness Month (1 December to 31 January) 04 World Braille Day 28 World Leprosy Day February Healthy Lifestyle Awareness Month Reproductive
More informationS.A. HEALTH CALENDAR 2016
S.A. HEALTH CALENDAR 2016 http://www.kznhealth.gov.za/health_awareness_days_2016.pdf We have a health poster set available 35 Laminated posters A3, full colour with a one pager of information. Contact
More informationHealth Calendar. January. February Souvenir TFW Pen Pocket Slider: Safe Dating
2019 Health Calendar January Blood Donor Month Cervical Health Awareness Month National Birth Defects Prevention Month National Glaucoma Awareness Month National Radon Action Month National Stalking Awareness
More informationJanuary. February. March
January 1-31 Birth Defects Prevention Awareness Month (National) 1-31 Blood Donor Month (National) 1-31 Cervical Cancer Screening Month 1-31 Cervical Health Awareness Month 1-Mar 31 Daffodil Days 1-31
More informationPast Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1
Appointment Date: Page 1 Chief Complaint: (Please write reason, symptoms, condition or diagnosis that prompts your appointment) Past Medical History PERSONAL SKIN HISTORY YES NO Yes - Details Melanoma
More informationJanuary. February. Recognition days events 10 Find A Dentist Day 20 Women s Healthy Weight Day 25 IV Nurse Day (National)
January 1-31 Birth Defects Prevention Awareness Month (National) 1-31 Blood Donor Month (National) 1-31 Cervical Cancer Screening Month 1-31 Cervical Health Awareness Month 1-Mar 31 Daffodil Days 1-31
More informationPUBLIC HEALTH INSTITUTE OF SOUTH AFRICA ANNUAL HEALTH CALENDAR 2013 JANUARY FEBRUARY MARCH APRIL. Sunsmart Skin Cancer Awareness Month
PUBLIC HEALTH INSTITUTE OF SOUTH AFRICA ANNUAL HEALTH CALENDAR 2013 JANUARY FEBRUARY MARCH APRIL (Sunsmart Skin Cancer Awareness ) Healthy Lifestyles Awareness TB Awareness Health Awareness Reproductive
More information2014 Cause Awareness Calendar
2014 Cause Awareness Calendar This is cause calendar was created to assist individual donors and businesses in planning their involvement and support of charities. This is a comprehensive list of multiple
More informationOver. Signature of Patient/Parent/Guardian: Date: / / Date: / / Patient s Name: For ADULT Patients : Employer: Address: Occupation:
Date: / / Patient s Name: Address: Preferred Home: ( ) - Work: ( ) - Cell: ( ) - Text Message Reminders : Yes No Social Security #: Date of Birth: - - / / For ADULT Patients : Employer: Occupation: Spouse
More informationLECOM Health Ophthalmology
Patient Name: Date of Birth: New Patient Questionnaire Your answers will be used by your healthcare provider get an accurate history of your medical conditions and ocular concerns. If you are uncomfortable
More informationPhysiological disorders
Physiological disorders Overview of major causes and signs and symptoms Learning Aim A: Tuesday 7 th February 2017 Grading Criteria Causative factors in physiological disorders Aetiology is the medical
More informationEVIDENCE-BASED VITAMIN AND MINERAL USAGE SUMMARY TABLE (APRIL 2002)
Acne Acrodermatitis Enteropathica Adrenal Support Age Related Cognitive Decline Alcoholism/Alcohol Withdrawal Alzheimer's Disease Amenorrhoea Anaemia Angina Anorexia Nervosa Anxiety Asthma Atherosclerosis
More informationAdult Health History
Patient Name Date of Birth Adult Health History This form will assist us in obtaining a complete medical history and health record on you. By completing this ahead of time it will also simply your visit
More informationCHRONIC CONDITIONS FYI
CHRONIC CONDITIONS FYI AIDS More than 2,500 cases of HIV/AIDS have been identified in Nebraska. ALS (Amyotrophic Lateral Sclerosis) Approximately 95 people in Nebraska have ALS. As many as 800 Nebraskans
More informationtime to say thank-you & a new year of & prosperity From IAHHC & to wish you a health, happiness, Katie Beth Sue Jean better happy holiday season is no
Evan Sue Michelle Jean There is no better time to say thank-you & to wish you a happy holiday season & a new year of health, happiness, & prosperity From IAHHC Katie Beth Savannah Board of Directors Flower:
More informationDiana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI P (734) F (734) New Patient Intake Form
Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI 48103 P (734) 547-3990 F (734) 547-3890 New Patient Intake Form Personal Information Name Age Sex Female Male Gender Identify
More informationCHRONIC TREATMENT GUIDELINES
CHRONIC TREATMENT GUIDELINES REGISTRATION OF CHRONIC CONDITIONS You can only access benefits for chronic medication, as listed below, if your prescribing/treating doctor or pharmacist registers your chronic
More informationComprehensive Screening (adult)
Comprehensive Screening (adult) Patient Name: _ DOB: / / Today s Date: / / Which type of visit does your daughter need today? Address a specific symptom or issue Medication questions/refills (list meds)
More informationPremium Specialty: Pediatrics
Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium
More information[Supplementary online-only material for Fiest KM, Fisk JD, Patten SB, et al: Fatigue and
[Supplementary online-only material for Fiest KM, Fisk JD, Patten SB, et al: Fatigue and comorbidities in multiple sclerosis. Int J MS Care. 2016;18(2):96 104.] Supplementary Table 1. Participants reporting
More informationPatient Name Date of Birth MALE / FEMALE Date. Left handed or Right handed. Marital Status: Single Married Divorced Widowed Children?
PH NEW PATIENT HISTORY Patient Name Date of Birth MALE / FEMALE Date Occupation: Left handed or Right handed Marital Status: Single Married Divorced Widowed Children? Y or N # Previous Treating Physician:
More informationAdult Neuropsychological Questionnaire
Adult Neuropsychological Questionnaire Note: If you need more space for any of the answers, please use the back page(s) to elaborate. Name: Date of Birth: Age: Sex: Highest Grade/Degree Completed: Dominant
More informationNAME DATE Page 1. Other. Kidney Removed (Right, Left) Bladder Removed. Ovaries Removed for Endometriosis Breast Biopsy
NAME DATE Page 1 Past Medical History: (please circle ALL that apply) Anxiety Hepatitis Arthritis Hypertension Artificial joints HIV/AIDS Asthma Hypercholesterolemia Atrial fibrillation Hyperthyroidism
More informationEvolve180 / Ideal Northwest Health Profile
Evolve180 / Ideal Northwest Health Profile ABOUT YOU First Name: Last Name: Address: City: State: Zip: Phone: Email: Date of Birth: Age: Height: Occupation: How did you find out about our program? Marital
More informationMeasuring Long-Term Conditions in Scotland - A summary report
Measuring Long-Term Conditions in Scotland - A summary report Introduction This summary report provides insight into: What are the most common long-term conditions in Scotland? What is the population prevalence
More informationPatient Intake Form for Allegany Ear, Nose, & Throat
Patient Intake Form for Allegany Ear, se, & Throat Patient Name: What brings you to the office today? Who is your primary care doctor? Please list your current medications: Are you allergic to any medications?
More informationDiagnosis-specific morbidity - European shortlist
I Certain infectious and parasitic diseases 1 Tuberculosis A15-A19 X X Z 2 Sexually transmitted diseases (STD) A50-A64 Y Z 3 Viral hepatitis (incl. hepatitis B) B15-B19 X Z 4 Human immunodeficiency virus
More informationMedical Reference Library Table of Contents
Medical Reference Library Table of Contents Alcoholism Anemia Anxiety Abdominal Aortic Aneurysm Asthma Atrial Fibrillation Attention Deficit Hyperactivity Disorder (ADHD) Barrett s Esophagus Bipolar Disorder
More informationF M S M W D. Age Birth Date Gender Marital Status Cell Phone
MIDWEST DERMATOLOGY CLINIC, PC Patient Legal Name Last First Middle Initial Today s Date Mailing Address Street City and State Zip Home Telephone F M S M W D. Age Birth Date Gender Marital Status Cell
More informationSEX AND GENDER IN CLINICAL RESEARCH TRAINING FOR INCLUSION
SEX AND GENDER IN CLINICAL RESEARCH TRAINING FOR INCLUSION C. Neill Epperson, M.D. Professor of Psychiatry & Ob/Gyn Perelman School of Medicine OVERVIEW History of sex and gender considerations in research.
More informationTO SERVE YOU MORE EFFICIENTLY, PLEASE COMPLETE THIS FORM AND RETURN IT TO THE FRONT DESK BEFORE YOU ARE CALLED TO AN EXAM ROOM. THANK YOU.
NEW PATIENT FORM TO SERVE YOU MORE EFFICIENTLY, PLEASE COMPLETE THIS FORM AND RETURN IT TO THE FRONT DESK BEFORE YOU ARE CALLED TO AN EXAM ROOM. THANK YOU. DATE: ACCOUNT NUMBER: AGE: NAME: DATE OF BIRTH:
More informationIntake and History Form
Name: Date: Street Address: City / State: Zip Code: Date of Birth: Gender: Soc. Sec. #: Phone Number (day): Phone Number (day): Email Address: Emergency Contact: # Preferred Language: _ Race: Ethnic Group:
More informationProvidence Medical Group
Providence Medical Group To our valued patients: In order to provide you with our full attention when you come for an appointment, we would like to ask you to be aware of the following guidelines. Insurance
More informationADULT INFORMATION SHEET
DATE: DOCTOR TIME ADULT INFORMATION SHEET FULL NAME NICKNAME: SEX: BIRTHDATE: AGE: SOCIAL SECURITY #: HOME PHONE #: CELL PHONE #: MAILING ADDRESS: STREET CITY: STATE: ZIP: PLACE OF EMPLOYMENT: E-MAIL ADDRESS:
More informationAn affiliate of Saint Mary's Health System FRANKLIN MEDICAL GROUP, PC. NEW PATIENT INTAKE FORM. Last Name: First Name: DOB: Age:
FRANKLIN MEDICAL GROUP, PC. NEW PATIENT INTAKE FORM Last Name: First Name: DOB: Age: Date of Service: Present Occupation: Marital Status: Married Divorced Single Widowed Partnered List household Members
More informationSan Luis Dermatology & Laser Clinic, Inc.
San Luis Dermatology & Laser Clinic, Inc. Patient Name: Pharmacy Name: Primary Care physician: LOCATION City: Health History Intake Form The federal government has defined a complete electronic medical
More informationInitial Consultation
Today s Date: Initial Consultation Thank you for choosing Apollo Health and Wellness. Please take your time to fill out this form. It will help us to concentrate on areas of your health that need attention
More informationHywel Dda University Health Board 3 Year Integrated Medium Term Plan 2016/ /19 Supporting and Enabling Plan Annex 20b
Hywel Dda University Health Board 3 Year Integrated Medium Term Plan 2016/17 2018/19 Supporting and Enabling Plan Annex 20b Communications & Engagement Overview of Activity 31 st March 2016 1 Communications
More informationPreferred Pharmacy. Past Medical History
Name: Date: Street Address: City / State: Zip Code: Date of Birth: Gender: Phone Number (day): Phone Number (evening): Email Address: Emergency Contact: Preferred Pharmacy Name: Phone Number: City and
More informationGeorgia Department of Human Services BIRTH FAMILY BACKGROUND INFORMATION FOR CHILD. Name of Child Date of Birth Sex Race Hispanic Ethnicity Yes No
Georgia Department of Human Services BIRTH FAMILY BACKGROUND INFORMATION FOR CHILD Name of Child Date of Birth Sex Race Hispanic Ethnicity Yes No Legal County (DHS Child) Resident County (Non-DHS Child)
More informationANY FAMILY HISTORY OF ANEURYSM OR DVT?
NAME: D/O/B: DATE: MR# WHAT PROBLEM(S) BRINGS YOU HERE TODAY? WHO SENT YOU TO US? DOCTOR/OTHER WHICH DOCTOR? WHAT SURGERY HAVE YOU HAD AND WHEN? (LIST) 1. 2. 3. 4. 5. 6. 7. HOW MUCH ALCOHOL DO YOU DRINK
More informationFeil & Oppenheimer Psychological Services
Feil & Oppenheimer Psychological Services 260 Waseca Ave. Barrington, RI 02806 401-245-4040 Fax: 401-245-1240 feiloppenheimer@gmail.com Adult Patient Questionnaire Name: Today's Date: Address: Home Phone:
More informationNew Patient Questionnaire. Name DOB Date
Medical History (This refers to medical problems that have already been diagnosed or treated. Please explain how this is treated, such as diet, medication, surgery, etc.) Condition Abnormal Pap smear Alcohol
More informationSTEPHEN P. NONN OFFICE OF THE CORONER MADISON COUNTY, ILLINOIS 157 MAIN STREET SUITE 354 EDWARDSVILLE, IL
MAIN OFFICE: (618) 692-7478 MORGUE: (618) 296-4525 FAX: (618) 692-6042 FAX: (618) 692-9304 STEPHEN P. NONN OFFICE OF THE CORONER MADISON COUNTY, ILLINOIS 157 MAIN STREET SUITE 354 EDWARDSVILLE, IL. 62025-1962
More informationPrioritized ShortList MORBIDITY
Report on in-depth analysis of pilot studies in 16 Member States on diagnosis-specific morbidity statistics Annex 2 (Rev 11_11_13) Prioritized ShortList MORBIDITY Legend: X recommended for collection Y
More informationBy Prime. Unique & Exclusive Cause-Related Items. primeline.com/awareness
2014 By Prime Unique & Exclusive Cause-Related Items PL-4025 2 Big Eco-Sipper AS LOW AS $2.39 (C) NEW! PL-1065 Awareness Ribbon Water Bottle AS LOW AS $3.49 (C) PL-4417 Avalon Clear Tumbler AS LOW AS $4.65
More informationc o m m u n i t y o u t r e a c h
c o m m u n i t y o u t r e a c h p r o g r a m knowledge of health care issues health education series Marion General Hospital s health education series consists of a kit with lesson plans and curriculum,
More informationDATE OF BIRTH: MELANOMA INTAKE
MELANOMA INTAKE GENERAL INFORMATION How was your first diagnosed? (Check the diagnosis that describes your condition.) Melanoma Merkel Cell Carcinoma Squamous Cell Carcinoma Basal Cell Carcinoma Other
More informationPatient Information: Date: Last Name: Street Address: City: SS #: First Name: Sex: M F Birthdate: Contact Information:
Welcome to PHC Family Medicine! We know you have a choice and appreciate your choosing us to provide care to your family. Dr. Frankhouser will be asking about your concerns today, but so that we can learn
More informationMEDICAL HISTORY. Previous Nephrologist. Medication taken Insulin Oral Both. Who manages your diabetes? Blindness Yes No Hearing Problems Yes No
MEDICAL HISTORY Please mark YES or NO and fill in appropriate blanks as needed Chronic Yes No If yes, year diagnosed Previous Nephrologist Transplant Yes No If yes, date Donor type Living Deceased Related
More informationMailing Address: Street City Zip
First Middle Last Mailing Address: Primary Phone: Street City Zip Secondary Phone: Date of Birth: Male Female SSN: Emergency Contact Phone: Marital Status: Single Race: American Indian or Alaska Native
More informationEgg Donor screening Questionnaire. How many years did you complete in high school?
Please tick ( ) and complete ALL questions. YOU YOUR PARTNER Full name Forename Surname Forename Surname Date of birth day / month / year day / month / year Address Height : Weight: Ethnicity Home Tel:
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: McCoy MS, Carniol M, Chockley K, Urwin JW, Emanuel EJ, Schmidt
More informationUnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty
UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty 666700 Acne Family Medicine, Internal Medicine, Pediatrics 438300 Acute Bronchitis Allergy,
More informationField underwriting pocketbook for life and critical illness insurance
500-5000 Yonge Street Toronto, Ontario M2N 7J8 www.ivari.ca ivari and the ivari logos are trademarks of ivari Canada ULC. ivari is licensed to use such marks. BW-LP1540 9/15 Field underwriting pocketbook
More informationBOTLHE MEDICAL AID SCHEME - APPLICATION FORM
What you must do 1. 2. 3. 4. 5. Once you have submitted your application form, here is what will happen: - If any details are missing or if we need more information for underwriting purposes, we will contact
More informationDenise L. Newman, Ph.D.
Denise L. Newman, Ph.D. Clinical and Developmental Psychologist ADULT HISTORY NAME: TODAY S DATE: BIRTH DATE: AGE: GENDER: (circle) Male Female Other MARITAL STATUS: ETHNICITY: HOME ADDRESS: EMAIL ADDRESS:
More informationHealth History Form Please Fill Out Entire Form
Health History Form Please Fill Out Entire Form Name: Primary Physician: Referring Provider: Review of Symptoms: Check all that apply Date of Birth: Phone: Additional Concerns: Eyes: Blurry Vision Burning/Dryness
More informationName: Date: Street Address: Referring Physician: How long have you had your current problem?
3851 Piper Street, Suite U464 Anchorage, AK 99508 p 907.339.4800 f 907.339.4801 New Patient Health Questionnaire Name: Date: Street Address: City: State Zip Sex: Age: Birth Date: Insurance: SS# Home Phone:
More informationCHRONIC CONDITIONS FYI
CHRONIC CONDITIONS FYI AIDS More than 2,500 cases of HIV/AIDS have been identified in Nebraska. Nationwide, this number is more than 1.2 million. ALS (Amyotrophic Lateral Sclerosis) There are 87 people
More informationPatient Last Name First Name Middle Name. Home Address City State Zip. Date of Birth Age Social Security # - - Cell Phone Home Phone Work Phone
Date Patient Last Name First Name Middle Name Gender (circle): Male Female Other: Marital Status (circle): Single Married Divorced Widowed Separated Home Address City State Zip Date of Birth Age Social
More informationo Kidney Cancer o Liver Cancer o Tremor o Tuberculosis o B12 Deficiency o Esophageal Cancer o Liver Disease o Pituitary Tumor o Uterine o Neurological
Adult New Patient Registration PATIENT DOB: / / MONTH DAY YEAR PATIENT NAME: LAST FIRST MI o Abnormal Heartbeat Patient Medical History: Please mark all that apply o Chronic Headaches o Hepatitis C o Neuropathy
More informationNotto Chiropractic Health Center Patient Information
Notto Chiropractic Health Center Patient Information Acct #: Name: Preferred Name: Address: City: State: Zip: Home Phone: ( ) - _. Work Phone: ( ) -. Who Referred You? In Case of Emergency: Phone Number:
More informationName (First Name and Last Initial ONLY) Date. Occupation. Education. Date of Birth Age Gender. How did you hear about AHE NYC World Student Clinic?
Name (First Name and Last Initial ONLY) Date Occupation Education Date of Birth Age Gender How did you hear about AHE NYC World Student Clinic? Family History Age If passed, cause of death Father Mother
More informationPharmacy and Referrals Pharmacy Name, Street Address & Telephone #: Primary Care Physician s Name, Location & Telephone #:
Patient Registration Please Print Clearly Date: Last Name: First Name: Middle Initial: Sex: Date of Birth: / / Age: Social Security: - - Address: City: State: Zip Code - Circle Preferred Phone Number Home
More informationCompany/Group Name: Business Telephone: Fax: Option 2:
Application Form Please read through the following before completing this application form in BLOCK CAPITALS. You must disclose all material facts. Failure to do so may invalidate the Cover. A material
More informationShallotte Vision Care J. Mark Saunders, OD PA 4637 Main Street Shallotte NC Patient Demographic Information
Shallotte Vision Care J. Mark Saunders, OD PA 4637 Main Street Shallotte NC 28470 Patient Demographic Information Account # Last Name: SSN: / / First: Middle: Marital Status: Single Married Separated Nickname:
More informationSCHNEIDER MEDICAL GROUP, PA History Intake Form (Please Print)
History Intake Form Patient Name: Date of Visit: Briefly State the reason for the visit: Date of Birth: Physician Use Only - History and Present: 1. 2. 3. 4. 5. Page 1 of 10 Review of Symptoms HEAD NO
More informationCUMULATIVE ILLNESS RATING SCALE (CIRS)
CUMULATIVE ILLNESS RATING SCALE (CIRS) The CIRS used in this protocol is designed to provide an assessment of recurrent or ongoing chronic comorbid conditions, classified by 14 organ systems. Using the
More informationPatient Information. Insurance Information
Thoracic Group, PA Hyperhidrosis Center at Thoracic Group PA Robert J. Caccavale, MD Jean-Philippe Bocage, MD (732) 247-3002 Patient Information Name: Date: Date of Birth: Social Security #: Street Address:
More informationWelcome to Medina Family Chiropractic and Acupuncture!
Welcome to Medina Family Chiropractic and Acupuncture! Please fill out this form and return it to the front desk. Let us know if you have any questions! Personal information Date: First name: Middle name:
More informationMemory & Aging Clinic Questionnaire
Memory & Aging Clinic Questionnaire The answers you give to the questions below will assist us with our evaluation. Each section is equally important so please be sure to complete the entire questionnaire.
More information34th St. and Civic Center Blvd, Philadelphia, PA 19104, phone
34th St. and Civic Center Blvd, Philadelphia, PA 19104, phone 215-590-3630 www.chop.edu/gastroenterology Please complete this form prior to your child s visit. Please fax to (215) 590-7224 or e-mail it
More informationNAME: DATE: SCHOOL/ORGANISATION:
HEALTH AND FITNESS NAME: DATE: SCHOOL/ORGANISATION: INSTRUCTIONS 1. Make sure you read the bold text in boxes throughout the worksheet as they contain important information. These boxes contain instructions
More informationWELCOME to the Florence Chiropractic and Wellness Center.
WELCOME to the Florence Chiropractic and Wellness Center. Thank you for choosing our practice for your chiropractic and wellness needs. Please complete this form in ink. If you have any questions or concerns,
More informationPLEASE COMPLETE ALL SECTIONS OF THIS FORM
PLEASE COMPLETE ALL SECTIONS OF THIS FORM Patient Name: Date of Birth: Referring Doctor? (Name, telephone number and address) Chief Complaint: Why have you come here? How did it start? What are the symptoms?
More informationHealth History Questionnaire
Health History Questionnaire Page 1 of 8 Thank you for choosing Martin s Point to be your partner in health. To help us give you the highest-quality care, please answer the questions on this form as well
More informationSURGERY SPECIALTY PATIENT HEALTH HISTORY
SURGERY SPECIALTY PATIENT HEALTH HISTORY Chief Complaint - Please describe the problem that brings you into the office today: Allergies 1. Do you have any allergies? if so, please list To Medications?
More informationDONE! You can now close the browser.
Visit My Doctor Online at kp.org/mydoctor. Prepare for your visit This form will help you prepare for your upcoming visit with your doctor. You can complete it on your computer (Mac or PC) and e-mail it
More informationHealtheCNY Indicator List by Data Source
American Community Survey 23 Adults with Health Insurance Children Living Below Poverty Level Children with Health Insurance Families Living Below Poverty Level Homeowner Vacancy Rate Homeownership Households
More informationWelcome to About Women by Women
Welcome to About Women by Women Today s Date New Patient Questionnaire Name: Birth Date: / / Home Phone: Address: Cell Phone: Work Phone: Occupation: Employer: Marital Status: Married Living w/ Partner
More informationLiver Health: Do you have liver problems? Yes No If so, please specify:
Medical History General Last Name: First Name: Date of Birth: Age: Contact Number: Are you in good health to the best of your knowledge Medical Information: Please list any physicians you see and their
More information11/20/18. MICROBIOME AND THE BRAIN: How your gut impacts Wellbeing. Agenda. Session 1 Reminder. Session Two. Sue Langley
MICROBIOME AND THE BRAIN: How your gut impacts Wellbeing Session Two Sue Langley 2018 2017 Langley Group IP Trust Agenda 2. Implications and research 1. Introduction to your microbiome 3. What next? Session
More informationList of Qualifying Conditions
List of Qualifying Conditions Cancer Conditions 1) Adrenal cancer 2) Bladder cancer 3) Bone cancer all forms 4) Brain cancer 5) Breast cancer 6) Cervical cancer 7) Colon cancer 8) Colorectal cancer 9)
More informationPatient History Form
Patient Personal Information Name: Date: Age: Occupation: Employer's name: Briefly describe your daily activities at work: Sex: male female Marital Status: single married divorced widowed Spouse's name:
More information- YOUR HEALTH HISTORY - (PLEASE COMPLETE ALL PAGES )
NAME (Please Print) First Name M.I. Last Name DATE of BIRTH / / - YOUR HEALTH HISTORY - (PLEASE COMPLETE ALL PAGES ) Exam Date:,20 PRESCRIPTIONS DRUGS Please Print MEDICATIONS NAMES ONLY NO PRESCRIPTION
More informationITG Diet Health Status Intake Form
Health Status Intake Form Date: Last Name: First Name: D.O.B: Address: City: ST: ZIP Phone: Cell: Email: Age: HT: WT: BMI: Fat %: Occupation: Sex: M F Marital Status: M S D W How did you hear about the
More information