History of Hospital and ER Visits

This form allows for one line tracking of each medical visit, with room to enter basic information for quick reference.  Keeping all the data in one place prevents time-consuming, anxious searching when it’s needed quickly.

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This picture is just to give you a general idea of what the forms will look like.  Turning the form into a picture has greatly reduced the quality, so there are distortions that do not appear in the actual form.