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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the patient's last name, middle name, and first name in the designated fields. Ensure all names are clearly written.
  3. Fill in the 'Date of Identification' in the provided space, ensuring accuracy for record-keeping.
  4. Indicate the reason for attention by selecting from options such as 'Prevention', 'Pregnancy', or others as applicable.
  5. Complete personal details including age and sex by selecting the appropriate options.
  6. Provide a detailed clinical history, specifying any relevant medical conditions or previous treatments.
  7. Document current ailments, including symptoms and their onset date, ensuring to include any related diagnoses using CIE-10 codes.
  8. Outline treatment plans and any complications encountered during treatment, along with hospital details and physician information.
  9. Finally, ensure that all sections are filled without omissions before signing off on the document digitally.

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