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4234 N Freeway Blvd., Ste 500, Sacramento, CA 95834, Phone: 9166483999 Fax: 9166481919 HISTORY AND PHYSICAL FOR ADULT DAY HEALTH CARE / COMMUNITY BASED ADULT SERVICES Patient Name: DOB: Phone Number:.

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How to fill out the Altamedix online

This guide provides detailed instructions on completing the Altamedix document online. Whether you are assisting someone or filling it out for your own use, these steps will help you navigate the process smoothly.

Follow the steps to fill out the Altamedix form effectively.

  1. Utilize the ‘Get Form’ button to access the Altamedix form and open it in the online editor.
  2. Enter the patient name in the designated field. Ensure that the name is recorded accurately as this is crucial for identification.
  3. Provide the date of birth (DOB) in the specified area. Input should follow the format requested.
  4. Fill in the phone number, ensuring you include the area code for accurate contact information.
  5. Complete the address fields including street address, city, and zip code. Double-check for accuracy.
  6. Proceed to the diagnoses and conditions section. Select the primary diagnosis by checking the appropriate box.
  7. If applicable, detail additional diagnoses by selecting from the various categories provided, using the checkboxes available.
  8. In the physical examination section, fill out the required metrics including temperature, pulse, respiratory rate, height, and weight.
  9. Complete the TB screening section by entering details from the relevant assessments, including PPD results and any notable health history.
  10. If there are medications, complete the medication profile diligently, inputting each medication’s name, dosage, route, and frequency.
  11. Indicate any allergies in the appropriate section to ensure comprehensive health records.
  12. Review the standing orders section and make necessary modifications by striking through any orders that are not applicable.
  13. Finalize by completing the request for adult day health care section, ensuring all fields are thoughtfully filled and signed by the primary care provider (PCP).
  14. Once completed, you can save your changes, download, print, or share the form as required.

Get started on completing your Altamedix document online today.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232