Medical History & Admission Exam - DIGITAL FORM
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Updated March 2023
Briggs Medical History and Admission Examination prompts the physician/physician extender review of body symptoms, diagnoses, past surgeries/procedures, immunizations, TB testing, health concerns, rehab potential, prognosis, awareness of diagnosis, and statement regarding communicable disease. Provision for Examiner comments/additional notes as well as recommendations for care are found on the reverse side.
This version also includes the PCV20 and PCV15 pneumococcal vaccines as well as COVID-19 boosters.
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*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
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*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.