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In this tutorial, you'll learn how to effectively gather and document patient information using techniques such as restatement, reflection, and clarification. Start the interaction by greeting the patient warmly, identifying and introducing yourself, and explaining your role. Choose a quiet, private area for the interview to protect confidentiality. Inform the patient that you're updating their medical records, emphasizing the importance of accurate information. Utilize therapeutic communication to complete the history form, collecting essential details like the patient’s full name, address, marital status, gender, age, date of birth, and contact numbers. Also, request insurance information and employer details, ensuring all data is correctly reflected in the electronic record as needed.
