Get St. Marks Hospital Patient Intake Form
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How to fill out the St. Marks Hospital Patient Intake Form online
Filling out the St. Marks Hospital Patient Intake Form online is an important step in preparing for your visit. This guide will help you navigate each section of the form with ease, ensuring that you provide all necessary information accurately.
Follow the steps to complete the form accurately and efficiently.
- Press the ‘Get Form’ button to access the Patient Intake Form and open it in your preferred editor.
- Begin by entering the date at the top of the form, followed by your full name and date of birth.
- Provide your phone numbers, including home, cell, and work numbers in their designated fields.
- List your referring physician's name, followed by your primary care physician's name.
- Indicate any allergies you have to medications, as well as describe any reactions to latex, iodine, contrast dye, or shellfish if applicable.
- List all current prescription and over-the-counter medications, indicating the medication name, dose/route, and frequency.
- Document all past surgeries by listing the surgery name, date, and any additional notes you find relevant.
- In the medical history section, check all conditions you have or have had from the categories provided.
- For social history, indicate your marital status, highest level of education, and work history by selecting the appropriate options.
- Answer questions related to alcohol and tobacco use, including how much and how often you consume them.
- Fill out the family history section by noting any significant health problems experienced by immediate family members.
- In the pain history section, provide detailed accounts of your pain, including when it began, past evaluations, and what therapies you have tried.
- Complete the scale for assessing your pain now, least in the past month, and most in the past month.
- Indicate pain location and type using the description in the provided drawing area.
- Once all sections are completed, ensure to save the changes to your form. You can then download, print, or share the submitted form as needed.
Complete your St. Marks Hospital Patient Intake Form online today for a smoother healthcare experience.
To email St. Thomas Hospital, you need to visit their official website where contact details are provided. The website typically includes a dedicated email address for patient inquiries and support. Ensure you mention any specifics about your situation in your email for accurate assistance. For your convenience, consider referring to the St. Marks Hospital Patient Intake Form for important patient information.
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