Transcription of Preventive Health Checklist
{{id}} {{{paragraph}}}
MyHealth JournalPartner with your personal doctor and play an active role in your Health and well-being. Keeping records and preparing for your visits will help you and your doctor create a plan that s right for you. Network Health wants to help you improve or maintain your Health . Use this journal to record your personal information and keep track of any concerns to share with your personal INFORMATION Name _____Date of Birth _____Member ID# _____Plan Name _____DOCTOR INFORMATIONP ersonal Doctor _____Phone _____Pharmacy _____Phone _____ Specialists _____ADVANCE DIRECTIVE/LIVING WILLq YES. I have an advance directive or living will. A copy has been given to _____q NO. I do not have an advance directive or living INFORMATIONName _____Relationship to Patient _____Phone _____Alternate Phone _____IN CASE OF EMERGENCYName _____Relationship to Patient _____Phone _____Alternate Phone _____Page 1q AIDS/HIVq Alcohol Abuseq Allergies List all _____ _____q Anemiaq Anxietyq Arthritisq Asthma or COPD/Emphysemaq Bladder Controlq Bleeding/Clotting Disordersq Bronch
Preventive Health Checklist I t can be tough to keep all the recommended preventive care and screenings straight, but they are crucial for early detection and treatment. Take this checklist to your next doctor’s appointment and review with your doctor to …
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document:
{{id}} {{{paragraph}}}