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  • PDL Health Record New 2022

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    Bhell Mendiola
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    24 views2 pages

    PDL Health Record New 2022

    Uploaded by

    Bhell Mendiola

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
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    A REPUBLIC OF THE PHILIPPINES Form No. t H) DEPARTMENT OF INTERIOR AND LOCAL GOVERNMENT y BUREAU OF JAIL MANAGEMENT AND PENOLOGY Final Remarks: LC) Release Ci Transfer Death aE a i oi 7) st Date of comeinent Name oa: ain oc Phibeath No Case: Case Ne Name fcontzt person Relationship Adress of contact person hove /Emal A INITIAL HEALTH ASSESSMENT Present Health Condition: Blood type: PAST MEDICAL HISTORY (Please enumeratedocument as applicable) eda istry Sites’ Chiihood Whesses | Allergies: War Raat inaseee | Widor Surgeries Previous Hospateaion | | Family History (uo to + dare) Seon PERS - | Co Hypertension D Stroke | inten Range on & Res eee | ‘Medications History pL Co Asthma Tio ani aso 1D Kiiney disease | | cancer [ona Ensioar Pes ot Past psychiatric history: Consutation with Psychiatrist ClYes TINO Hfyes, when? | Confinement in a psychiatic faci: Yes CONo — Ifyes, when? Where? _ Diagnosis - Medication taken ARVtreatment: ClYes CNo tyes, ffommoory)____J-_Plave: ‘OBIGYNE history: LMP two Gi Vaccines: (Frown) ALCOHOL HISTORY Alcohol drinker: CIYes CNo Age atonset___ Frequency of use per week ‘Type of drinks containing alcohot ‘Approximate volume of alcohol consumed: (bate, 96s, shot, te) ‘SMOKING (TobaccolCigarette/Vape] (Never smoked Current smoker Passive smoker) Stopped>ayear _C] Stopped

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