Patient Profile
Street Address: ________________________________________________________ Suburb: ____________________ State: _______
Are you pregnant? ______________________
Do you go to tanning booths? _____________________________________________ Are you currently sun or wind burnt: _______________________________________ Do you get facial waxing/electrolysis/or use depilatories? ______________________ (Wait 5 days between treatments.)
Have you had any dermal fillers in the last week? _____________________________ What is your occupation? ________________________________________________ Do you participate in vigorous sports or aerobic activity? _____________________________________________________________________ Have you ever had a peel before? ________ or within the last 14 days?____________ What kind? ___________________________________________________________ Describe your reaction: _________________________________________________ Have you had recent facial surgery?________________________________________ Are you allergic to: (circle all that apply) Milk, apples, citrus, grapes, Aloe Vera, Aspirin, or any essentials oils?
Any other allergies? If so, what? _________________________________________ Describe your skin: (Circle all that apply) Normal, Oily, T-Zone/Combination, Freckled, Sun-Damaged, Uneven/ Blotchy, Mature, Wrinkled, Saggy, Firm, Large pores, Small pores, Acne, Milia, Blackheads, Breakouts, Cysts, Scarring, Melasma, Rosacea, Telangiectasia Broken-Capillaries, Sallow, Hype pigmented, Hypo pigmented.
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Do you consider your skin to be sensitive or resilient? ________________________ Eye Colour: (Circle one) Blue, Green, Hazel, Grey Light, Brown, Dark Brown
Hair Colour: (Circle one) Blonde, Red Light, Brown, Medium Brown, Dark Brown, Black, Grey/Silver White
Skin Tone: (Circle one) Pale White, Light Reddish/Freckles, Light Olive, Medium Olive, Dark Olive, Brown, Dark
What is your heritage? _________________________________________________
How do you heal from a cut? Circle one Brown pigment/ Pink then fades to white Are you using/ have you used:
(If yes, please advise) ____________________
Where do you apply it?____________________
Accutane: _________________ How long for? ______________________________ Hormone/other medication: _____________________________________________ Glycolic or other AHA home care products. If so, which one(s)? _____________________________________________________________________ How does your skin react to them? _____________________________________________________________________ Have you ever used any products that caused a bad reaction? Please describe: _____________________________________________________________________ _____________________________________________________________________ Do you smoke? ________________________Get cold sores? ___________________ What is your home skin care regime? _____________________________________________________________________ _____________________________________________________________________ What about your skin bothers you and what would you like to have improved? _____________________________________________________________________ _____________________________________________________________________ Treatment Recommendation: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Skin Specialist:__________________________________ Date: ___________________________________
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Traction- mechanical pull applied to a part of the body• Applied to arms, legs, neck, back, pelvis• Fractures, dislocations, muscle spasms, • HUC communicates traction order to person responsible for assembling, PT in sm hosp. • External apparatus applied by nursing, HUC orders supplies such as moleskin tape, sling, • Sample Doctor’s orders for Traction:• Cervical tractio
What Is Cholesterol-Lowering Medicine? If your doctor has decided that you need to take medicine to reduce high cholesterol, it’s because you’re at high risk for heart disease or stroke. Usual y the treatment combines diet and medicine. Most heart disease and many strokes are caused by a buildup of fat, cholesterol and other substances cal ed plaque in the inner wal s of your arteries. The