PATIENT ADMISSION QUESTIONNAIRE - MetroVan Urology 2025

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The document is a Patient Admission Questionnaire from Richmond Hospital, part of the Vancouver Coastal Health Authority. It collects essential medical history and current health information from patients, including questions about past medical conditions, medications, allergies, and lifestyle habits. The form is designed to ensure comprehensive patient assessment prior to admission.

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Click ‘Get Form’ to open the PATIENT ADMISSION QUESTIONNAIRE in our editor.
Begin by entering your personal information at the top of the form, including your name, sex, date of birth, weight, and height.
Carefully review each medical history question. For each item listed, check the appropriate column (Yes, No, Not sure) based on your current health status.
If you take any medications or have allergies, ensure to fill out those sections accurately. List all medications along with their dosage and frequency.
Complete the second page by detailing any past operations and providing additional information that may be relevant for your admission.
Once all fields are filled out, review your responses for accuracy before saving or submitting the form directly from our platform.

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