Get Ak Sunshine Community Health Center Pediatric Patient Intake Form 2021-2025

Completing the AK Sunshine Community Health Center Pediatric Patient Intake Form online is an important step in ensuring your child's health needs are addressed. This guide provides a clear, step-by-step approach to help you navigate the form efficiently and accurately.

Follow the steps to complete the intake form successfully.

1. Click ‘Get Form’ button to obtain the Pediatric Patient Intake Form and open it for editing.
2. Begin by entering the patient's name, date of birth, and today's date in the designated fields. Be sure to double-check the accuracy of this information.
3. Provide the names of the parents or guardians in the 'Parents’ Names' section, followed by the patient's school and grade.
4. Indicate any known allergies. If the patient has no allergies, check the box next to 'None.'
5. In the 'Current Medications, Vitamins, Supplements' section, list any that the patient is currently taking. If there are none, select 'None.' If unsure, choose 'Unsure.'
6. Outline any existing health problems the patient may have in the 'Patient’s Health Problems' field, providing detail as necessary.
7. Record any previous hospitalizations, surgeries, or injuries in the appropriate section.
8. Review the list of health conditions. Indicate whether the patient has ever experienced any by selecting 'Y' for yes or 'N' for no for each listed condition.
9. Fill in the 'Review of Systems' section by marking which symptoms the patient has experienced within the past six months using 'Y' or 'N.'
10. Answer the lifestyle and family history questions, selecting 'Y,' 'N,' 'Unsure,' or 'N/A' as needed.
11. If there are any known medical problems in the family, list them in the provided space.
12. Once you have completed the form, save your changes. You may also choose to download, print, or share the form as needed.

Complete the Pediatric Patient Intake Form online today to ensure your child's health care needs are met.