ComprehensiveHealthAppraisal-1

ComprehensiveHealthAppraisal-1 - NameofClient:_...

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Name of Client:_________________________ Health Appraisal Do you have a physician in town?  Name: Yes No History of Heart  Disease – Have  you experienced: A heart attack? If  so, when? Heart surgery? If  so, when? Cardiac  catherization? If so,  when? Coronary  angioplasty  (PTCA)? If so,  when? Pacemaker/implant able cardiac  defibrillator/rhythm  disturbance? If so,  when? Heart valve  disease? If so,  when was it  diagnosed? Heart failure? If so,  when? Heart  transplantation? If  so, when? Congenital heart  disease? If so,  when was it  diagnosed? Yes No Current Health  Status - Do you  have: Diabetes? If so,  when was it  diagnosed? Learning Outcome 1/Method 2 (BESS, Major in HFM) Revised  11/16/11
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Name of Client:_________________________ Asthma or other  lung disease? If so,  when was it  diagnosed? Kidney disease? If  so, when was it  diagnosed? Liver disease? If so,  when was it  diagnosed? A known heart  murmur (associated  with  cardiomyopathy or  aortic stenosis)? If you are a female,  are you pregnant or  do you think that  you might be  pregnant? Yes
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ComprehensiveHealthAppraisal-1 - NameofClient:_...

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