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How to fill out the New Patient Questionnaire: Pediatric Epilepsy - Johns Hopkins online
The New Patient Questionnaire for Pediatric Epilepsy at Johns Hopkins is designed to gather essential information that will aid in the evaluation and care of your child. This guide provides clear instructions on how to complete the form accurately and effectively before your clinic visit.
Follow the steps to fill out the New Patient Questionnaire effectively.
- Click the ‘Get Form’ button to access the New Patient Questionnaire and open it in your preferred editor.
- Begin by entering the patient’s name and date of birth in the designated fields. This ensures the medical records are correctly associated with your child.
- Provide the patient's address and contact information for the primary caretaker, including home, cell, and work phone numbers, as well as an email address.
- Input the date of the upcoming clinic visit to schedule the necessary appointment clearly.
- Indicate the name and relationship of the person filling out the form, ensuring you note if it is a parent or guardian.
- List all referring physicians and healthcare providers involved in the patient’s care, including their addresses and phone numbers, for potential communication.
- In the consent section, as the legal guardian, print your name, your child’s name, and the date for the medical record release.
- Provide the patient’s age, hand dominance, and any relevant medical history regarding previous seizures, infections, or injuries prior to seizure onset.
- Detail your child’s symptoms, including duration, severity, and any patterns identified to provide context for the medical team.
- Complete sections about previous treatments, allergies, birth history, developmental history, family history, and social history as accurately as possible.
- Review the section regarding the review of systems, checking any relevant symptoms and providing details where necessary.
- Once all answers have been provided, save the completed questionnaire. You may then choose to download, print, or share it as needed.
Ensure you complete and submit your New Patient Questionnaire online prior to your visit for a smoother appointment.
The 3Cs in epilepsy stand for clinic, community, and connection. These components emphasize the importance of comprehensive care and support systems for individuals with epilepsy. Using the New Patient Questionnaire: Pediatric Epilepsy - Johns Hopkins ... - Hopkinsmedicine, families can bridge the gaps between medical advice and community support effectively.