General Medicine Clinic: Dr C Osuji

Chief complaint - please tell us how we can help Today's date Since your last visit to the office, were you admitted to the hospital? Since your last visit to the office, have you had any medical test? If yes, please check any that apply: List where and when you had the tests done Since your last visit to our office, have you developed new allergies or had a bad reaction to medication or food? If yes, describe Since your last isit to our office, have you seen a specialist (such as a doctor for diabetes, heart, kidneys, cancer, eyes, gynecology, etc.)?? If yes, who did you see and when? Since your last visit to our office, have you had any vaccinations (shots)? If yes, check the shots you received Please list Since your last visit to our office, have you started any new prescribed medications? Is yes, please list Name Date of Birth