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Microsoft Word - PointsToWellness NewPatient History and Disclosures.doc
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Document Date: 2014-08-09 19:48:10


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File Size: 139,53 KB

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City

Website / /

Company

Y Primary Insurance Company / Points To Wellness Inc. / Self N Group / Google / /

Currency

USD / /

/

Facility

Professional Building / /

IndustryTerm

insurance submissions / federal law / days services / insurance-portion / bank / insurance plan / insurance / car accident / healthcare operations / food / /

MedicalCondition

e.g. allergies/asthma / headache / intestines Bruise / fainting / ribcage Chronic / difficult delivery miscarriages / hives / pneumothorax / nausea / Known allergies / Allergy / numbness / pain / vomiting / Fatigue / spontaneous miscarriage / diarrhea / Infection / dizziness / illness / allergies I / injuries / /

MedicalTreatment

moxibustion / Immunizations / Surgeries / acupuncture / counseling / emergency treatment / massage / /

Organization

American Arbitration Association / /

Person

Jennifer McGrath L.Ac / Jennifer McGrath / /

Position

therapist / counsel / care physician / arbitrator / party arbitrator / physician / Major / Representative / General / neutral arbitrator / /

Product

Coumadin / /

Technology

cellular telephone / /

URL

www.PointsToWellnessInc.com / /

SocialTag