Newreflectionsps.com

Nikesh K. Patel, MD
axã exyÄxvà|ÉÇá cÄtáà|v fâÜzxÜç 509 Stillwells Corner Road, Suite E5
Freehold, New Jersey 07728
(732) 354-3792

Please complete Medical History Form to the best of your ability
Name ___________________________________________________ Age _____ Height _______ Weight ___________
Purpose of Consultation
__________________________________________________________________________________________________
How did you hear about Dr. Patel? ____________________________________________________________________
Please circle all of the following medical conditions that you have or have had in the past:
Bleeding tendency hepatitis diabetes blood transfusion glaucoma dry eyes lung disease TB asthma
wheezing emphysema bronchitis irregular heartbeat chest pain heart disease heart attack stroke
epilepsy heartburn intestinal ulcers or bleeding depression mental illness drug or alcohol addiction any other
serious injury or illness
Please list any medications or herbal products that you take on a regular or occasional basis. If you can, please also
include dosage and frequency:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please circle any medications that you are currently taking: Birth control pills aspirin ibuprofen containing drugs
diet pills diabetic medications steroids glaucoma drops asthma medications Lanoxin nitroglycerin Isordil
Inderal other heart medications Lasix other diuretics high blood pressure medications Coumadin Plavix
tranquilizers sleeping pills antidepressants other pills or shots
Do you have any allergies to medications? ____________ If so, please list drug and reaction: _____________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Has anyone in your family or you ever suffered from diabetes, high blood pressure, breast cancer or odd reactions to
anesthesia. Please list:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Smoking can complicate surgery:
Do you or have you ever smoked?________ If so, how much and for how long? _________________________________
Please list all previous surgeries that you have had :
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Patient Signature: _______________________________________ Date: _________________ rev. 8/08

Source: http://www.newreflectionsps.com/forms/Medical_History_Form.pdf

Foster contra el pluralismo.pmd

Episteme, Eutopías, Documentos de trabajo, vol. 186, Valencia,España, 1998, 24 págs. Reprod. en: La Gaceta de Cuba , LaHabana, nº 5, septiembre-octubre del 2000, pp. 34-39 Contra el pluralismo * El arte existe hoy día en un estado de pluralismo: ningún estilo, o siquieramodo de arte, es dominante y ninguna posición crítica es ortodoxa. Peroeste estado es también una posición, y est

Hedp_a_443705_o

EDUCATIONAL PSYCHOLOGIST, 45 (1), 15–27, 2010Copyright C Division 15, American Psychological AssociationISSN: 0046-1520 print / 1532-6985 onlineDOI: 10.1080/00461520903433539Cognitive–Situative Divide and CombiningIn this article we propose that in order to advance our understanding of motivation in collab-orative learning we should move beyond the cognitive–situative epistemological di

Copyright © 2014 Medical Pdf Articles