Standort in Deutschland, wo man günstige und qualitativ hochwertige Kamagra Ohne Rezept Lieferung in jedem Teil der Welt zu kaufen.

Kaufen priligy im Online-Shop. Wirkung ist gut, kommt sehr schnell, innerhalb von 5-7 Minuten. cialis was nur nicht versucht, verbrachte eine Menge Geld und Nerven, und geholfen hat mir nur dieses Tool.

Drkares.us

Use the opposite side of the page as necessary to complete your answers. Please print legibly.
Name ______________________________________________________________________________________ Address ____________________________________________________________________________________ Phone (w) __________________________ (h) _________________________ (c) _________________________ DOB __________________________ Age ______________SS# ______________________________________ Emergency Contact ___________________________________________________________________________ Relationship to patient _________________________________ Phone __________________________________ Primary care physician _________________________________ Phone _________________________________ Date of last physical __________________ Have you ever had an EKG? ( ) N Date _____________________ Current or past medical conditions (check all that apply) ( ) Cardiovascular (heart attack, high cholesterol, angina) Other (Please describe) ___________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ If there a family history of any of the illnesses listed above, please put an “F” next to that illness MD NOTES __________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Is there a family history of anything NOT listed here? (Please explain) __________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ MD NOTES ________________________________________________________________________________ ___________________________________________________________________________________________ Have you ever had surgery or been hospitalized? (Please describe) ____________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ MD NOTES ________________________________________________________________________________ ___________________________________________________________________________________________ Have you or a family member ever been diagnosed with a psychiatric or mental illness? (Please describe) ___________________________________________________________________________________________ Have you ever taken or been prescribed antidepressants? ( ) N For what reason ________________________ Medication(s) and dates of use ______________________________ Why stopped ________________________ Please list all current prescription medications and how often you take them (example: Dilantin 3x/day). DO NOT include medications you may be currently misusing (that information is needed later) ______________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Please list all current herbal medicines, vitamin supplements, etc. and how often you take them ___________________________________________________________________________________________ MD NOTES ________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Please list any allergies you have (penicillin, bees, peanuts) _____________________________________________________________________________________ MD NOTES _________________________________________________________________________ Have you ever been treated for substance misuse? ( ) N (Please describe when, where and for how long) ________________________________________________________________________________ How long have you been using substances? Did you ever stop using any of the above because of dependence? ( ) N (Please list) _____________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ What was your longest period of abstinence? ______________________________________________________ ___________________________________________________________________________________________ MD NOTES ________________________________________________________________________________ ___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Source: http://www.drkares.us/Documents/Mediical_HistoryTHP.pdf

Under the spotlight - swine flu

Under the Spotlight Synopsis: This article provides a brief overview of the swine influenza of current concern Swine Influenza Introduction With the recent extensive news media coverage of a potential swine influenza (or ‘swine flu’) pandemic, a substantial volume of information is available through public health and other internet-based sources. Accordingly, the

Microsoft word - instructions - pre procedure.dot

Southeastern Pain Consultants, P.C. 770 982-2099 Pre Procedure Instructions Take all of your prescription medications as prescribed on the day of your procedure EXCEPT those noted below: Stop all anti-platelet drugs one week prior to your procedure and restart them after the procedure. Examples of drugs in this class include: anagrelide (Agrylin), clopidogrel (Plavix), dipyridamo

Copyright © 2010-2014 Internet pdf articles