Documents tagged "Medical History"

Found 2 documents with this tag

DOJ-OGR-00026332.jpg

The image displays a document with multiple columns of text information on a white background. The document appears to be a form or report with headings and various fields filled out. There is visible text including words such as "Date," "Name," "Address," "Phone Number," "Email Address," and sections labeled "Patient Information," "Medical History," and others that are not fully legible due to the resolution of the image. The document seems to be a medical or healthcare-related form, given the context of patient information typically requested in such documents.

Phone Number Email Address Patient Information Medical History Date Name Address Phone Number Email Patient Information Medical History

DOJ-OGR-00026268.jpg

The image displays a document with a list of items related to health and medical issues, specifically mentioning "Health Problems" at the top. Below that heading are bullet points labeled "Current Health Problem," followed by sub-points indicating categories such as "Pain," "Dental Issues," and several others. The text is too small and blurry to read specific details or names. There's also a section titled "Medical History," with a list of dates and corresponding medical events, but again, the text is not legible due to the image quality.

Health Problems Current Health Problem Dental Issues Medical History Health Problems Below Current Problem Pain Dental Issues Medical History