Health Questionnaire
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How to write a Health Questionnaire? Download this Health Questionnaire template that will perfectly suit your needs.
Our collection of online health templates aims to make life easier for you. Our site is updated every day with new health and healthcare templates. By providing you this health Health Questionnaire template, we hope you can save precious time, cost and efforts and it will help you to reach the next level of success in your life, studies or work!
Have you or any applying family member been diagnosed as having or been treated for AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS-Related Complex) n Yes n No 7) Alcohol or substance abuse, mental/nervous disorders n Yes n No 8) Ulcer, colitis, difficulty swallowing, stomach problems, hernia or rectal problems n Yes n No 9) Diabetes, cystic fibrosis, albumin or sugar in the urine or other endocrine problems n Yes n No 10) Asthma, emphysema, tuberculosis, pleurisy or other diseases of the lungs n Yes n No 11) Paralysis, epilepsy, MS or other neuromuscular disorder n Yes n No 12) Bleeding or blood disorders except HIV n Yes n No (continued) CA89632 (2/12) Health Net of California, Inc..
This Health Questionnaire is intuitive, ready-to-use and structured in a smart way. Try it now and let this Health Questionnaire sample inspire you.
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Also interested in other health and healthcare templates? AllBusinessTemplates is the most elaborate platform for downloading health templates and is updated every day with new health and healthcare related templates! Just search via our search bar or browse through our thousands of free and premium health forms and templates, contract, documents, letters, which are used by professionals in the healthcare industry. For example health care directive, mental health treatment plan, health management report, allergy log, healthy weekly meal plans, sick leave letter, health evaluation form, and much more...
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