E DISCORSO INDIRETTO (DIRECT SPEECH AND REPORTED SPEECH)
|
|
- Gwenda Nichols
- 5 years ago
- Views:
Transcription
1 Preface Grammar focus GRAMMAR INITIAL TEST PLURALE (PLURAL) ARTICOLO DETERMINATIVO (DEFINITE ARTICLE) ARTICOLO INDETERMINATIVO (INDEFINITE ARTICLE) 0 AGGETTIVI E PRONOMI INDEFINITI (INDEFINITIVE ADJECTIVES AND PRONOUNS) 1 2 My father s surgery 3 4 COMPARATIVI (COMPARATIVES) SUPERLATIVI (SUPERLATIVES) 5 6 The air around us IMPERATIVO (IMPERATIVE) PRESENTE (PRESENT) Checking for consciousness 0 PASSATO REMOTO (PAST) PASSATO PROSSIMO (PRESENT PERFECT) 4 5 TRAPASSATO (PAST PERFECT) FUTURO (FUTURE) DISCORSO DIRETTO E DISCORSO INDIRETTO (DIRECT SPEECH AND REPORTED SPEECH) PASSIVO (PASSIVE) Haemophilus influenzae type b 9 Acquired immuno-deficiency syndrome and human immunodeficiency virus infection 0 1 Abortion 2 Heart kept beating outside the body 3 Procedure in the operating theatre TRANSLATION Exercise B INITIAL TESTS Exercise B Exercise C Medical topics WORKING WITH EXERCISES ON SCIENTIFIC LEXICON Hippocratic Oath Human body Human body Radiology Fluoroscopy Ultrasound Magnetic resonance imaging Nuclear medicine Interventional radiology Teleradiology 0 1 Symptoms, examination, and therapy 2 Healthcare career 3 Healthcare professions 4 Disorders and diseases
2 ENGLISH FOR HEALTHCARE PROFESSIONS Medical laboratory and biomedical research 0 The structure of a research article The admission day 5 Medical facility 6 Healthcare providers 7 People in medicine 8 9 Physical examination 0 Individual scientist vs team scientists 1 2 Headaches quiz This is what the surgeon is doing These are the instruments the surgeon needs 8 9 Surgery for headache 0 Head injury 1 Surgical interventions 2 3 Suture Doctor s evaluation Decision making 7 Mastectomy 8 Heart transplant 9 A road accident 0 1 Plastic surgery 2 Breast implant surgery - General or local anaesthesia? 3 4 Anaesthesia 5 Local, regional and general anaesthesia 6 Transplant 7 Hormone replacement therapy 8 Thyroid test 9 Hyperthyroidism Goitre Hypothyroidism 0 Thyroiditis Thyrotoxicosis Thyroid cancer 1 Liver 2 Diabetes insipidus 3 4 Autonomic nervous system 5 Brain and nervous system 6 Alzheimer s disease 7 Billions of neurons 8 Assessing a patient 9 Epilepsy 0 Schizophrenia 1 Parkinson s disease quiz 2 Autism 3 Schizophrenia quiz Drugs 7 Drug dependence 8 Drugs and sports 9 Decongestants 0 Drugs used in diabetes 1 Drugs for infertility 2 3 Drugs for psoriasis 4 Antiemetics 5 Oral contraceptives 6 Anticancer drugs 7
3 Bronchodilators 8 Paracetamol 9 Antipruritics 0 Conventional and natural medicine 1 Aromatherapy 2 Acupuncture: a Chinese method to control surgical pain 3 Defensive medicine Surgical and medical tools 8 9 Respiratory system 00 Bronchitis 01 Pneumonia quiz 02 an asthma attack 03 Artificial respiration 04 Smoking quiz 05 What is pneumonia? Nursing 09 Urinary diversion Urinary retention 10 Urine test 11 Pharmacology 12 CardioPulmonary Resuscitation (CPR) 13 Nosebleeding 14 Cardiac/respiratory arrest 15 Fainting 16 Choking 17 Severe bleeding 18 Poisoning the various poisonings 19 Heat exhaustion 20 Heatstroke 21 Microscope Circulary system of the blood 42 Cholesterol Sneezing Operating room theatre Musculoskeletal system Human skeleton Sprain sprains and strains Structure of bone 68 Osteoporosis Fractures 69
4 ENGLISH FOR HEALTHCARE PROFESSIONS 70 Osteoarthritis 71 Arm sling Hemiplegia 75 Gout Rheumatoid arthritis Opening the airway 90 Endocrine system Heart 94 Heart and circulation 95 Heart attack 96 Coronary heart disease 97 Heart pathologies 98 Cardiology quiz 99 Stroke 00 Deep vein thrombosis 01 Arrhythmia Wythenshawe Hospital in Manchester Bodily lesions and symptoms 08 Skin 09 Skin problems 10 Hypothermia 11 Frostbite 12 Jaundice 13 Psoriasis 14 Psoriasis quiz 15 Allergy 16 Allergy quiz 17 Bulimia Malignant and immune disease Types of cancer 23 Leukaemia 24 Symptoms of anaemia Bone tumours 27 Hodgkin s lymphoma 28 Cancer victims Cancer Reproductive and urinary tracts 36 Testicle (hydrocoele, hypogonadism, varicocoele, orchitis and torsion) 37 Cystitis Surgical and therapeutic interventions 41 Reproductive system quiz Diseases and of female reproductive system 44 Diseases and of male reproductive system 45 emergency childbirth 46
5 Sexually-transmitted infections 47 Urologist visit Eyes and ears 51 Care of the clients with eye and ear 52 Bilateral congenital glaucoma 53 Eye wound an eye wound Digestive system Gastrointestinal tract 61 Metabolism 62 Gastroenteritis 63 Coeliac disease Structure of a tooth 68 Dentistry Postoperative advice 78 Haemorrhoids 79 Rheumatoid arthritis Rheumatic fever Chronic rheumatic heart disease Chorea 80 Antiviral drugs Vaccines and immunization Risks and special precautions 81 Genetics Cloning challenge Parts of the body expressions 89 Human body s systems Lymphatic and immune system Digestive system Skeletal system Muscular system - muscle structure Nervous system - nerve structure Cardiovascular system Blood circulation Respiratory system Parts of the lung 0 Urinary system 1 Parts of the kidney 2 Reproductive system 3 Skin 4 Musculoskeletal 5 Nervous system 6 Cardiovascular 7 Infections and immune 8 Digestive 9 Reproductive 0 Cancer 1 Glossary
In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed.
Name: SS# In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed. Patient Medical, Surgical and Family History Review
More informationANAESTHESIA QUESTIONNAIRE: (TO BE COMPLETED BY THE PATIENT (POSSIBLY TOGETHER WITH THE GP))
Version No. 1.0 Valid from dec 2016 Document number DC 491 Unit Anaesthesia ANAESTHESIA QUESTIONNAIRE: (TO BE COMPLETED BY THE PATIENT (POSSIBLY TOGETHER WITH THE GP)) Together with your treating physician,
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 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 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 informationIndex. 1 The nurse 1. 2 Healthcare professionals Grammar Vocabulary... 11
Index 1 The nurse 1 Nurses and patients.... 1 1.1 Grammar.... 2 1 The infinitive... 2 2 Personal pronouns: subject.... 2 3 To be: simple present.... 2 4 Definite articles.... 6 5 Indefinite articles....
More informationNew Patient Paperwork
New Patient Paperwork Date: Phone: Patient: Last Name First Name Initial Street Address: City/State/Zip Code: Sex: M F Age: Birthdate: Single Married Widowed Separated Divorced Email: Newsletter? Y N Insured
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 informationPatient Name: DOB: Age: Sex: Male Female Height: Weight: Dominant Hand: Right Left HISTORY OF PRESENT ILLNESS
CAPS PAINCARE Page 1 of 5 Today s : / / SSN (last 4 digits): xxx-xx - Patient Name: DOB: Age: Sex: Male Female Height: Weight: Dominant Hand: Right Left Type of Accident/Injury: Auto Work Personal Injury
More informationPharmacotherapy Handbook
Pharmacotherapy Handbook Eighth Edition Barbara G. Wells, PharmD, HP, FCCP, BCPP Dean and Professor Executive Director, Research Institute of Pharmaceutical Sciences School of Pharmacy, The University
More informationHolistic Massage Diploma Assessment Book
Holistic Massage Diploma Assessment Book # Contents Contents... 2 Study Tips & Suggestions... 3 Assessment Questions... 5 The Application of Massage... 5 Contraindications & Cautions... 7 The Need for
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 informationMorris Medical Center, P.A.
Today s date: Name : Age Date of Birth Height Weight Right hand dominant Left hand dominant Sex: Male Female Chief Complaints; Current Pain Level (0 ~ 10) 0 1 2 3 4 5 6 7 8 9 10 Average Pain Level (0 ~
More informationPatient s name Patient s phone numbers Emergency contact name Emergency contact phone number Relationship to patient
Advocate Condell Wound Healing Center 801 South Milwaukee Ave, West Tower Libertyville, IL 60048 847-990-5670 Patient s name Patient s phone numbers Emergency contact name Emergency contact phone number
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 informationAthens Rheumatology Clinic, LLC Sana Makhdumi, MD
Athens Rheumatology Clinic, LLC Sana Makhdumi, MD Phone: 706-850-8322 Fax: 706-850-8322 PATIENT HISTORY FORM Date of first appointment: / / Time of appointment: Birthdate: Name LAST FIRST MIDDLE INITIAL
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 informationCHAPTER 3. The Human Body National Safety Council
CHAPTER 3 The Human Body The Human Body Composed of many different organs and tissues All parts work together: To sustain life Allow activity Injury or illness impairs functions 3-3 Cranial located in
More informationNurseAchieve. CHAPTERS INCLUDED IN THE NURSEACHIEVE COMPREHENSIVE NCLEX REVIEW NURSING SKILLS AND FUNDAMENTALS:
NurseAchieve www.nurseachieve.com CHAPTERS INCLUDED IN THE NURSEACHIEVE COMPREHENSIVE NCLEX REVIEW NCLEX TEST STRATEGIES: NCLEX EXAM OVERVIEW TEST TAKING STRATEGIES NURSING SKILLS AND FUNDAMENTALS: ADMINISTRATION
More information5.2 Main causes of death Brighton & Hove JSNA 2013
Why is this issue important? We need to know how many people are born and die each year and the main causes of their deaths in order to have well-functioning health s. 1 Key outcomes Mortality rate from
More informationHEALTH QUESTIONNAIRE
HEALTH QUESTIONNAIRE NAME AGE SEX: Male / Female DATE COMPLETED: OCCUPATION EMPLOYER HEIGHT WEIGHT BIRTHDATE DOMINANT HAND: Left / Right NAME OF YOUR PRIMARY CARE PHYSICIAN (INTERNIST OR PEDIATRICIAN):
More informationHamilton Back Clinic
Hamilton Back Clinic Intake Form Name: City: Address: Postal Code: Phone: Sex: M F Date of Birth: Month/Day/Year E mail: Emergency Contact: Name/Phone: Name of Family Physician (MD): Employer: Employer
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 informationPATIENT INFORMATION FORM (WOMEN ONLY)
PATIENT INFORMATION FORM (WOMEN ONLY) Name: Age: Sex: Birthdate: / / SS # A. Describe briefly your present symptom(s) or the reason(s) for seeing the doctor today: B. Name all illnesses or conditions for
More informationDNA CENTER New Patient Information
DNA CENTER New Patient Information Name Email: Address City State Zip Home Phone Work Cell Phone Social Security Number Date of birth Gender ( Male/Female) Age Please Circle: Hispanic/Latin or Non Hispanic/Latin
More informationFor Office Use Only: MA complete Date of Visit / / mm/dd/yyyy. This form must be scanned into the medical record. Do not remove from clinic.
For Office Use Only: MA complete Date of Visit / / mm/dd/yyyy This form must be scanned into the medical record. Do not remove from clinic. UWMC Women s Health Care Center & SCCA Women s Cancer Center
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 informationUnityPoint Clinic - Cardiology
UnityPoint Clinic - Cardiology Date Completed: Appointment Date: Name: Age: Birthdate: / / FIRST MIDDLE INITIAL LAST Referred by: Family Dr.: Reason for visit: Describe briefly, include date of onset:
More informationBarbara G. Wells, PharmD, FASHP, FCCP, BCPP Dean and Professor School of Pharmacy, The University of Mississippi Oxford, Mississippi
Barbara G. Wells, PharmD, FASHP, FCCP, BCPP Dean and Professor School of Pharmacy, The University of Mississippi Oxford, Mississippi Joseph T. DiPiro, PharmD, FCCP Panoz Professor of Pharmacy, College
More informationPharmacology for the Health Care Professions
Pharmacology for the Health Care Professions Christine M. Thorp University of Salford, UK )WILEY-BLACKWELL A John Wiley & Sons, Ltd., Publication Contents Foreword Preface Acknowledgements xüi xv xvii
More informationCHAPTER 3. The Human Body National Safety Council
CHAPTER 3 The Human Body Lesson Objectives 1. Describe the primary areas of the body. 2. List the 10 body systems and explain a key function of each. 3. For each body system, describe at least 1 injury
More informationHighland Colony Dental- Donald K. Givan, DMD
Highland Colony Dental- Donald K. Givan, DMD ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRAcTICES *You May Refuse to Sign This Acknowledgement* I, have received a copy of this office s Notice of Privacy
More informationVASCULAR SURGERY PATIENT HEALTH HISTORY
VASCULAR SURGERY 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? To
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 informationDid you complete the Sports Ware Online required information (
Dear New VSU Student Athlete and Parent/Guardian, Welcome to Virginia State University. It is important that a safe and knowledgeable environment is maintained for you, the student-athlete, the athletic
More informationMEDICAL RECORD. Last and given name(s)... Personal Identification Number PESEL.. Residence address... Phone number..
MEDICAL RECORD Last and given name(s)... Personal Identification Number PESEL.. Residence address... Phone number The person authorised by the patient to be contacted and receive information concerning
More informationPharmacy Prep. Qualifying Pharmacy Review
Pharmacy Prep 2014 Misbah Biabani, Ph.D Director, Tips Review Centres 5460 Yonge St. Suites 209 & 210 Toronto ON M2N 6K7, Canada Luay Petros, R.Ph Pharmacy Manager, Wal-Mart, Canada 1 Disclaimer Your use
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 informationMedical Questionnaire
MEDICIS Health Testing Center Avenue de Tervueren 236 115 Bruxelles Tel : 2/762.5.44 Medical Questionnaire Name :. Maiden name : First name :. Sex :. Address :...... Phone (private) : Office :. Date of
More informationMedical Questionnaire
Medical Questionnaire Date: Day Month Year Please answer these questions as completely as you can. We realize that this form is long, but the information in this form will be extremely valuable to us in
More informationSelected tables standardised to Segi population
Selected tables standardised to Segi population LIST OF TABLES Table 4.2S: Selected causes of death, all-ages, 2000 2004 (Segi Standard) Table 5.3S: Public hospitalisations by major cause of admission
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 informationHealth 8 Physical Education and Health
Scope And Sequence Timeframe Unit Instructional Topics 10 Day(s) 5 Day(s) 10 Day(s) 15 Day(s) 10 Day(s) 5 Day(s) Body Systems Reproductive System Communicable and Noncommunicable Diseases Alcohol, Tobacco,
More informationTYPES OF DOCTORS. Dermatologist - This is a doctor that treats any ailment related to the skin and its appendages such as hair, nails etc.
Cardiologist - A cardiologist is certified to treat any problem dealing with heart diseases and cardiovascular diseases. Dentist - Any dental problem from tooth decay to dentures to retainers are handled
More informationNew Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care
Page 1 of 7 Patient Demographics First Name* Last Name* Date Of Birth* Home Phone* Mobile Phone Phone Gender* Email Preferred Communication Street Address 1* Street Addresss 2 Zip* City* State* Emergency
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 informationEvaluating Exam Review Book and Guide
Pharmacy Prep Evaluating Exam Review Book and Guide Misbah Biabani, Ph.D Director Toronto Institute of Pharmaceutical Sciences (TIPS) Inc. Toronto, ON M2N 6K7 Pharmacy Prep Professional Exams Preparation
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 informationWhat do you believe is causing your most important health concern?
Intake form Name Today s Date Date of Birth Address City Phone Postal Code Email Primary Health Care Provider Emergency Contact Phone Note: By providing your email address you are giving us consent to
More informationCHRONIC PAIN EVALUATION. Please help us understand your pain by completing this drawing:
JOSE G. VELIZ MD, INC. Diplomate of the American Board of Interventional Pain Management Diplomate of the American Board of Anesthesiology Diplomate of the American Board of Pain Medicine Fellow of Interventional
More informationPatient History Form
Patient History Form Advanced Directive Care Plan? Yes No Name: Birth date: / / Address: Age: Sex: F M STREET DAY YEAR Telephone: Home ( ) CITY STATE DAY YEAR MARITAL STATUS: Divorced Separated Alive/Age
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 informationNew Patient Information
Geoffrey G Glidden MD PA New Patient Information Name Address City/State/Zip Cell Phone Home Phone DL# SSN# Age of Birth Sex: Male / Female Your employer Occupation Work Phone E-Mail Referring Physician
More informationIntensity: 0-10 (10 is the worse pain you have ever experienced in your life that you would want to jump from a building, 0 is no pain)
Patient Questionnaire: Name: Date: Occupation: Date of Birth: Age: Sex: Male Female Referring Physician: Chief Complaint: Describe your Pain: sudden onset gradual constant intermittent worsening improving
More informationPATIENT MEDICAL HISTORY INTAKE FORM
Northgate Professional Center 1985 Main Street, Suite 209 Springfield, Massachusetts 01103 Tel; 413-455-1081 Fax; 413-391-7489 www.marimedconsults.com PATIENT MEDICAL HISTORY INTAKE FORM Patient Information:
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 informationPharmacology 260 Online Course Schedule Summer 2015
Pharmacology 260 Online Course Summer 201 The topics listed below do not necessarily correspond to a 1 - hour lecture period. You should cover the topics for each week at some time during that week. Readings
More informationDr. Sereena Uppal DC Michael Herrewig DC Doctor of Chiropractic th Avenue Surrey BC V4A 2H9 Tel: Fax:
Dr. Sereena Uppal DC Michael Herrewig DC Doctor of Chiropractic 690 15355 24 th Avenue Surrey BC V4A 2H9 Tel: 604.541.9336 Fax: 604.541.9308 I. Patient Information Thank you for choosing our practice for
More informationClinical Pharmacology and Drug Therapy
Oxford Textbook of Clinical Pharmacology and Drug Therapy THIRD EDITION D. G. Grahame-Smith CBE, MBBS, PhD, FRCP Emeritus Professor of Clinical Pharmacology, University of Oxford and J.K. Aronson MBChB,
More informationFAMILY MEDICINE New Patient Medical History Form
FAMILY MEDICINE New Patient Medical History Form Personal History : Name: Date of Birth / / (mm/dd/yyyy) Age Occupation Birthplace (City&Country) Marital Status (check one): Single Married Divorced Separated
More informationMEDICAL HISTORY FORM FOR FOLLOW-UP
MEDICAL HISTORY FORM FOR FOLLOW-UP ID NUMBER: 0a) Form Date... / / 0b) Staff Code... Instructions: Whenever numerical responses are required, enter the number so that the last digit appears in the rightmost
More informationDEPARTMENT OF MEDICINE Outpatient Intake Form
NAME: Last First Middle Initial Date of Birth: ADDRESS: HOME PHONE: WORK PHONE: Did someone refer you here? Yes No If yes, please give name: Main reason for your visit today: MEDICAL HISTORY: (Please check
More informationPlease list any medications you currently taking along with dosage and directions (including birth control, vitamins and OTC medications):
Name: DOB: Date of Appointment: Please list all doctors you currently see (Primary Care Physician and Specialists i.e. Cardiologist): Please list any medications you currently taking along with dosage
More informationTEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM
TEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM PATIENT NAME: DATE OF BIRTH: TVA Physician being seen: Date of Visit: PAST MEDICAL HISTORY HEART PROBLEMS NEUROLOGICAL Congestive Heart Failure
More informationPersonal &Work Information Date: Patient Name: Age: City: State: Zip: Primary Care Physician: PCP Phone:
Personal &Work Information Date: Patient Name: Age: Birth Date: / / Preferred Name: Gender: Home Phone: Address: Mobile Phone: City: State: Zip: Occupation: Employer: Work Phone: Email: Emergency 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 informationDEPARTMENT OF MEDICINE Outpatient Intake Form
NAME: Last First Middle Initial Date of Birth: ADDRESS: HOME PHONE: WORK PHONE: Did someone refer you here? Yes No If yes, please give name: Main reason for your visit today: MEDICAL HISTORY: (Please check
More informationHealth screening questionnaire
Health screening questionnaire High Road Buckhurst Hill Essex IG9 5HX Tel: 020 8936 1202 Fax: 020 8936 1191 Visit: theholly.com Title: Surname: Forenames: Date of birth: Age: Address: Tel no. (Home): Tel
More informationPatient Name: Date of Birth:
Patient Name: Date of Birth: Marital Status: Single Married Divorced Widowed Height: Referring Doctor: Weight: Primary Care Dr.: Preferred Pharmacy:(name/address) ALLERGIES: Do you have any drug allergies?
More informationCooper Neurological Institute Phone: Fax:
Cooper Neurological Institute Phone: 856-968-7965 Fax: 856-968-8697 PATIENT INFORMATION AND HEALTH HISTORY Name: Date: Birth date: Age: Home Phone: Cell Phone: If patient is a minor or disabled, please
More informationPatient Name (First, Middle, Last) Height Weight. Ethnicity Race Language. Address. City State Zip. Home Phone Cell Phone. Work Phone Other Phone
Patient Name (First, Middle, Last) Height Weight Date of Birth Social Security # Gender Male Female Ethnicity Race Language Address City State Zip Home Phone Cell Phone Work Phone Other Phone Email Occupation
More informationSyncope and Seizure Questionnaire
Syncope and Seizure Questionnaire World College of Neurology 2/79 Wheatley Drive Bull Creek WA 6149 T 08 93320488 F 08 93329988 Copyright 2011. All rights reserved. Patient Name: MAIN PROBLEM I am here
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 informationPlease be sure to check with your insurance company to make sure that Dr. Kohli is covered under your plan.
Dear You are scheduled for an appointment with Dr. Manoj Kohli at Christie Clinic in the Department of Rheumatology on at. Please check in on the first floor. The office is located on the 2 nd floor of
More informationPatient Name: Date of Birth: Preferred Pharmacy: (name/location/phone #)
Patient Name: Date of Birth: Referring Doctor: Primary Care Dr: Preferred Pharmacy: (name/location/phone #) CURRENT MEDICATIONS: Please list all Medication Dose Frequency 1 2 3 4 5 6 7 8 9 10 11 12 13
More informationThe information you provide us will greatly help us provide the highest quality and most comprehensive care for you.
Rheumatology (circle location of appointment) 111 Hundertmark Rd. Suite 115N 560 S. Maple St. Suite 400 place patient label here Chaska, MN 55318 Waconia, MN 55387 952-361-2450 952-361-2450 The information
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 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 informationArchived SECTION 18 - DIAGNOSIS CODES. Section 18 - Diagnosis Codes 18.1 GENERAL INFORMATION PRIOR CONTENTS NO LONGER APPLICABLE...
SECTION 18 - DIAGNOSIS CODES 18.1 GENERAL INFORMATION... 2 18.2 PRIOR CONTENTS NO LONGER APPLICABLE... 2 18.3 DIAGNOSIS CODE LISTING... 2 Ambulance Manual 1 SECTION 18 DIAGNOSIS CODES 18.1 GENERAL INFORMATION
More informationCell Phone #: Home Phone #: ** Address (prefer your forever address):
NEW PATIENT QUESTIONNAIRE * Some of this information is required by the CMS (Centers for Medicare and Medicaid Services). Your demographic answers will never affect your care. Today s Date: **Date of Birth:
More informationJoseph S. Weiner, MD, PC Patient History Form
Date: / / NAME: Last First M. I. Age: Sex: q F q M Birthdate: / / What specific questions or goals do you have for this appointment? Please list the names of other clinicians you have seen for this problem:
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 informationName: (Last), (First), (Middle) Date of Birth: SS: Left or Right Handed: Complete Address: Phone: Home: Cell: Work:
An Outpatient Department of PLEASE FILL OUT ALL INFORMATION COMPLETELY Date Completed Name: (Last), (First), (Middle) Date of Birth: SS: Left or Right Handed: Complete Address: Phone: Home: Cell: Work:
More informationMONTEFIORE MEDICAL CENTER TRANSPLANT PROGRAM LIVING DONOR EVALUATION FORM History Questionnaire
MONTEFIORE MEDICAL CENTER TRANSPLANT PROGRAM LIVING DONOR EVALUATION FORM History Questionnaire Donor s Name: Today s Date: Social Security #: Date of Birth Age Sex Address: Telephone #: (home) (work)
More informationName of Pa. tient: Last. First. per day) 50 mg. X-ray dye or. IV contract. Name (Last) (First) Address. City, state/ zip code
Division of Cardiology for the Academic Medical Center of the University of Texas Medical School at Houston NEW PATIENT HISTORY FORM Please complete and fax to 713-512-2245 Name of Pa tient: Last _ First
More informationPLAS/RECON SURGERY PATIENT HEALTH HISTORY
PLAS/RECON SURGERY 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 informationMIAMI-DADE COLLEGE. Common Course Number: HSC Course Title: Basic Emergency Care. Course Catalog Description:
Common Course Number: HSC 2400 MIAMI-DADE COLLEGE Course Title: Basic Emergency Care Course Catalog Description: Designed to provide opportunities to develop, practice, and display skills concerning emergency
More informationDr. Hall New Patient Paperwork Please fill out these forms completely
Dr. Hall New Patient Paperwork Please fill out these forms completely Date of Appointment Complete the enclosed packet and bring it to the appointment along with all X Rays, MRI disc and reports. Please
More informationMedical History Form
Medical History Form NAME DOB / / TODAY S DATE MEDICAL HISTORY What medical Conditions do you have? Select all that apply, or write in if not listed: Diabetes High Blood Pressure Thyroid Disorder Heart
More informationMedical History Form
General: Medical History Form 1. Chief Complaint: What are the main health concerns you wish to address? 2. Current and Past Treatment: Have you received treatment for these problems? Yes No, if yes, which:
More informationRHEUMATOLOGY PATIENT HISTORY FORM
!! RAMOS RHEUMATOLOGY, PC RHEUMATOLOGY PATIENT HISTORY FORM Date: / / NAME: Birthdate: / / Last First M. I. Age: Sex: F M Marital status: Never married Married Divorced Separated Widowed Partnered/significant
More informationAttending Physician s Statement
( Form A A This form is used for claiming the social insurance benefit. This form should be completed and signed by the attending physician outpatient and One form for each month, one form for hospitalization
More informationAssignments for SUM Program Beginning Medical Transcription, 2nd edition
Assignments for SUM Program Beginning, 2nd edition SECTION 1 Introduction, Dermatology/ Plastics Body () Unit 1, Body as a Whole, Ch. 1, Organization of the Body; Ch. 4, Tissues, Glands, etc., Ch. 5, Integumentary
More information3. Are you now, or have you been in the past year, under the care of a physician?
Medical History Patient Name Birth Date ID Number 1. Do you have any of the following diseases or problems? Today s Date a. Active Tuberculosis b. Persistent cough greater than 3 weeks in duration c. Cough
More informationAmarillo Surgical Group Doctor: Date:
Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:
More informationRevolutionizing Treatment * Restoring Hope * Improving Lives
Revolutionizing Treatment * Restoring Hope * Improving Lives 6802 S. Olympia Ave., Suite G100 Tulsa, Oklahoma 74132 Phone: 918-949-6676 Fax: 918-949-6670 Please fill out the all paperwork and bring it
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 informationPatient Medical Information. Last. Sex: M / F Age: Date of Birth: Home Address: City: State: Zip Code: Business Address: City: State: Zip Code:
Patient Medical Information Name: First Middle Last Sex: M / F Age: Date of Birth: Social Security # Driver s License # Home Address: City: State: Zip Code: Home Phone: Occupation: Cell: Employer: Business
More informationGender: M F Race: Caucasian African American Hispanic Other
Weight Loss Surgery Patient Information First Name: Middle Initial: Last: Date of Birth: Age: Social Security #: Gender: M F Race: Caucasian African American Hispanic Other Address: City: State: Zip: Home
More informationMedication Allergies
**PLEASE CHECK IN 15 MINUTES PRIOR TO APPOINTMENT WITH FORMS COMPLETED** Primary Provider at Ocotillo Internal Medicine Other Physicians you see: Jonathan Hackenyos, D.O. 1. Cheryl Maurice, M.D. 2. 3.
More information