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Manipulative therapy / Alternative medicine / Medical prescription / Methadone / Acupuncture / Physical therapy / Medicine / Health / Patient safety


AA Spine & Pain Clinic- PATIENT REGISTRATION PATIENT INFORMATION: (Please Print) Date:__________________ Last Name:________________________
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Document Date: 2015-06-12 17:40:23

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File Size: 665,91 KB

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City

Anchorage / /

Company

ti s A / /

Currency

USD / /

Event

Product Issues / /

Facility

PHARMACY INFORMATION / HOW DID YOU HEAR ABOUT OUR CLINIC / Pain Clinic / Preferred Local Pharmacy / /

/

IndustryTerm

insurance carriers / governmental healthcare regulations / /

MedicalCondition

ALLERGY HISTORY / COPD / HIV / Surgeries/Injuries / Stroke / acquired immunodeficiency syndrome / Pain / injury / No Known Drug Allergies / drug abuse / AIDS / infection / illness / Lupus / injuries / sexually transmitted diseases / /

MedicalTreatment

Chemotherapy / Physical Therapy / Radiation / /

MusicGroup

Pain / CLINIC / Spine / /

NaturalFeature

Lake Otis Pkwy. / /

Organization

Intervention Tens Unit / /

Person

Ai / Cord Stim / /

/

Position

Hea rt / Care Physician / ve Hea rt / performed /

Product

Coumadin / Innohep / Plavix / bones / /

ProvinceOrState

Alaska / /

Technology

Biofeedback / Radiation / X-Ray / Chemotherapy / Radio Frequency / MRI / /

SocialTag