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- Witness to Witness (W2W)
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Adult Health History Questionnaire
Adult health history qustionnaire with a number of social and behavior related questions.
Files
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- AdultHealthHistoryQ ( 520 Kb )
Adult Medical History Form1-SPANISH
A Spanish version of the Adult Medical History Form.
Files
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- HISTORIADESALUDDELADULTO ( 61 Kb )
Adult Medical History Form2-SPANISH
A Spanish translation of the Adult Medical History Form.
Files
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- HistoriaMedica ( 63 Kb )
Brief Sex History Questionnaire
This questionnaire may be used as part of the review of systems
with patients. The clinician might begin, "I need to ask a few
short questions about your sexual health in order to be thorough
in providing your medical care."
Files
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- p4401 ( 41 Kb )
Depo-Provera Interval History Form
A sample Depo-Provera interval history form in English and Spanish.
Files
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- IntHistDepoEngSpan ( 37 Kb )
Oral Contraceptive Interval History Form
A sample oral contraceptive interval history form in English and Spanish.
Files
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- IntHisOCSEngSpan ( 42 Kb )
Social History Form-SPANISH
A Spanish translation of the 1-page sample social history form.
Files
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- HistoriaSocial ( 36 Kb )
Surgeon General's Family Health History Tool
The U.S. Department of Health and Human Services has released an updated and improved version of the Surgeon General's internet-based family health history tool. The new tool makes it easier for patients to assemble and share family health history and can also help practitioners make better use of health history information. For more detailed information about the new tool, please visit the website listed.
