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- Spring 2008 -

Seasonal Allergies

RI Dept Health Info on Tuberculosis

Common Cold from Mayo Clinic

Nasal Irrigation Video Mayo Clinic

Stomach Flu (Viral Gastroenteritis) and Rehydration

Charts for Blood Sugar & Blood Pressure

Brisk Daily Walk Improves Metabolic Profile

Aquatic Exercise Mayo Clinic Link

Diabetes Center Mayo Clinic Link

more...
New Patient FormFollow Up Visit
WebMD Health Headlines
Panel: New Tools Help Smokers Quit
Body Contouring Surgery Improves
Ginseng May Help Treat Schizophrenia
Few Aware of Stroke Warning Symptoms
Gamma Knife Snips OCD in Bud
CDC: 52% With Diabetes Have Arthritis
To Avoid Dementia, Watch Your Weight
Withdrawal Symptoms From Smoking Pot?
New Guidelines for Osteoporosis in Men
Antipsychotics in Kids May Add Weight
Computers May Play Role in Some School Shootings
Safest Spot for Baby's Car Seat?

Follow Up Visit Form

Please complete before your follow-up visit; This pay become part of your permanent record if you choose. If you would prefer to print this form, please use the printable Followup Visit Form Please be aware that we may not be able to address more than a few issues during your visit.

* Required
* Patient Name:
* Appointment Date:    * Time: 
Add to your
permanent record?:  Yes    No

* Reasons for Visit:
Annual Physical Exam  Asthma or Allergy recheck  
Blood Pressure recheck  CDL Physical  
Cholesterol recheck  Colds and Upper Repiratory symtoms  
Diabetes recheck  Dietary Discussion  
Immunizations  Labwork request  
Motor Vehicle Accident
(Please give details - ER-evaluation, XRays, Medications, followup and referrels, lawyer involvement)
  Prescription refills  
School or Sports Physical  Semi-Annual Exam  
Sore Throat  Sports Injury  
Work-Related Injury  Other (fill in below)  

* Details of Illness
Please give details of illness and why you need to be seen; list how long you have been ill and whether you have been to a treatment center, ER, etc.; list any medications or treatments you have received.

Medication Refill(s)
Please list medications to be refilled and whether 30 day or 90 day supply

Paperwork and Forms
Please list forms to be completed; e.g. CDL, School Physicals, Insurance, Disability, etc.
Note: There may be a charge for completion of these forms.

Do you have any questions for the nurse or doctor?