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W (4) Tj W 1 1 8.4684 8.4684 re W endstream endobj 297 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream n 2.414 2.9774 Td 1 1 8.4683 8.4684 re 0 0 10.4683 10.4684 re PDF | The development and standardization of the Women's Health Questionnaire (WHQ) is described. /ZaDb 6.6672 Tf Asthma, Diabetes, … Name: DOB: Height: Weight: Hospital Used: Reason for Visit Today: ALLERGIES: List a. ll . n q d . /Tx BMC ET 0.749023 g 0 0 10.4683 10.4684 re [Ƭ�������Qw��]|{T]�x|4:Yw����+��ş��N����nt��{���������xes���g���h�����%��Y���'k��:h�/5 5�����ts|4\ܚ��5{���j�w�0��ߎJ]�^Y� ���Z�N��k7�0%M��L�o������Nc�oo}�]]u#�)Jk�)^CcU�kH�U��޸2*�x�ǡ��CӘ�L�?�Nl�0�3Kw��T�v���0�� ���,H���?fݘ�p�>�o͕˷���ϭ �� �T]�=�����ˣ�A���[{�����櫣�������kw����u���m�~�#�]W�3�;���u���V݀WCWC�2���(�y� ��x��ß endstream endobj 195 0 obj <>/Subtype/Form/Type/XObject>>stream (4) Tj endstream endobj 221 0 obj <>/Subtype/Form/Type/XObject>>stream 2.414 2.9774 Td f _____ How often? HEALTH HISTORY QUESTIONNAIRE. Q /Tx BMC BT FREE 10+ Sample Health Questionnaire Forms in PDF | MS Word A health questionnaire is usually used to record the medical history of a patient. 2.414 2.9774 Td 1 1 8.4683 8.4684 re Q All information is kept confidential. 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(4) Tj W The medical significance of tracking the family genogramcame to light with the developments in medical genetics. (4) Tj BT n endstream endobj 269 0 obj <>/Subtype/Form/Type/XObject>>stream 1 1 8.4684 8.4684 re W 1 1 8.4683 8.4684 re n Your answers on this form will help your health care provider get an accurate history of your medical concerns and conditions. 1 1 8.4683 8.4684 re 2.414 2.9774 Td H�E��}�+���N��M+��������[�J�A�����x��W�� o�U�.x-ό}���w�DTcN0��4ju�7�1O�����1q�W� )�y endstream endobj 274 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream All responses are confidential. 2 0 obj f EMC HEALTH HISTORY QUESTIONNAIRE All questions contained in this questionnaire are strictly confidential and will become part of your medical record. All of your answers will be confidential. (4) Tj n endstream endobj 260 0 obj <>/Subtype/Form/Type/XObject>>stream W S:\Forms & Handouts\Health history forms\NutritionHealthInformation.docx Revised 2015-10-16 Nutrition and Health Information Questionnaire . Hernia, or any condition that may be aggravated by lifting weights or other physical activity q q. HEALTH-HISTORY . 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