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Wholeearthdentistry.com

MEDICAL HISTORY
Patient's name _______________________________________________ Phone ( ) Physician's name _____________________________________________ Phone ( ) Last seen approximately ____________________ Reason for visit ____________________________________ Are you under the care of a physician? □ Yes □ No If yes, for what condition(s)? _______________________ _________________________________________________________________________________________ Please list al medications you are currently taking ( Please include al prescription medication, over the counter medication, herbal remedies and vitamins)_______________________________________________________ _________________________________________________________________________________________ Please list any drug/medication al ergies _________________________________________________________ _________________________________________________________________________________________ Have you had any serious il ness in the last five years? □ Yes □ No If yes, please describe ________________________________________________________ Have you had any operations in the last five years? □ Yes □ No If yes, please describe ________________________________________________________ Have you ever responded adversely to medical or dental treatment? □ Yes □ No If yes, please describe _________________________________________________________ Have you experienced any major life changes or stressful events in the previous 12 months? □ Yes □ No Have you ever had any of the fol owing? (check al that apply) □ Developmental disorder (Type ____________________) Please list any other medical conditions or il nesses you may have that where not listed above: _____________ _________________________________________________________________________________________ _________________________________________________________________________________________ Do you use tobacco products? □ Yes □ No If yes, what type of product do you use? ____________________ How often do you use product?_____________________ How much do you use? _______________________ Have you had IV bisphosphonate (eg. Aredia or Zometa) therapy? □ Yes □ No
Have you ever taken oral bisphosphonate (eg. Actonel, Boniva, Fosamax, Skelif, or Didronel) therapy?
□ Yes □ No Women Only: Are you pregnant? □ Yes □ No □ Maybe Are you nursing? □ Yes □ No Are currently using birth control? □ Yes □ No Is there anything else in your medical history we should know about? __________________________________ _________________________________________________________________________________________ Dental History
Reason for today's visit: ______________________________________________________________________ Date of last dental care ________________________ Date of last dental x-ray _________________________ Month Year Month Year Have you experienced any of these problems? (check al that apply) □ Sores or growths in your mouth □ Gag easily List any dental problems you have experienced that are not listed: ____________________________________ _________________________________________________________________________________________ How often do you floss? _______________________ How often do you brush? _________________________Have you ever felt anxious about receiving dental treatment? □ Yes □ No Please let us know if you have any special areas of concern: ______________ Signature of patient (or parent, if minor)
Patient number

Source: http://www.wholeearthdentistry.com/docs/Medical_Dental_History.pdf

Thomas lemke: „gesunde körper – kranke gesellschaft

Gesunde Körper – kranke Gesellschaft? Medizin im Zeitalter der Biopolitik In den aktuellen Debatten um die moderne Medizin, ihre wissenschaftlichen Fortschritte und ihre sozialen Folgen fehlt etwas. In Ethikräten, Enquetekommissionen und den Pressefeuilletons sind naturwissenschaftliche, juristische, philosophische und theologische Positionen in der Regel sehr gut vertreten, wen

kongzl.ntou.edu.tw

The new england journal of medicinepuzzling that the authors repeatedly state that Two new books offer long answers for the obesity is a biologic rather than a behavioral char­ treatment of obesity, and each comes from a dif­acteristic, that adolescents and young women are ferent perspective. Treatment of the Obese Patient, a vulnerable to the psychosocial impact of nega­ well­ref

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