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HEALTH HISTORY
Answer all questions by circling Yes (Y) or No (N)
All responses are kept confidential
Are you taking or have you ever taken Bisphospho-
nates for osteoporosis, multiple myeloma or other cancers (Reclast, Fosamax, Actonel, Boniva, Are you now under a physician’s care for Have you ever been advised not to take a medication? Have you ever had any serious illnesses,
Please list any and all medications taken, including operations or hospitalizations? If so, describe:.Y N prescription medications, diet drugs, over-the-counter medications, herbal or holistic remedies, vitamins or minerals: DO YOU HAVE OR HAVE YOU EVER HAD:
A.
Rheumatic Fever or Rheumatic Heart Disease?.Y N ARE YOU ALLERGIC TO OR HAVE YOU HAD AN
Cardiovascular Disease (Heart Attack, Heart ADVERSE REACTION TO:
Trouble, Heart Murmur, Coronary Artery Disease, Angina, High Blood Pressure, Stroke, Palpitations, Lung Disease (Asthma, Emphysema, COPD, Chronic Cough, Bronchitis, Pneumonia, Tuberculosis, Seizures, Convulsions, Epilepsy, Fainting or Chemicals or jewelry (rash or sensitivity)?.Y N Bleeding Disorder, Anemia, Bleeding Tendency, Other allergies or reactions? Please list.Y N Blood Transfusion? Do you bruise easily? .Y N 10. Is there any past history of Alcohol or Chemical Dependency or Emotional Disorder that may affect 11. Have you had any serious problems associated with 12. Have you or an immediate family member had any (Heart Valve, Pacemaker, Hip, Knee)? .Y N problem associated with intravenous anesthesia?.Y N Radiation (X-ray) treatment for Cancer? .Y N 13. Do you have any other disease, condition or Clicking or popping of jaw joint, pain near ear, problem not listed above that you think the doctor difficulty opening mouth, grind or clench teeth? .Y N 14. Do you wish to talk to the doctor privately Any disease, drug or transplant operation that has depressed your immune system? .Y N 15. Have you ever had a bone density scan? .Y N ARE YOU USING ANY OF THE FOLLOWING:
16. FOR WOMEN ONLY
Are you Pregnant, or is there any chance
Aspirin or drugs such as Motrin, Aleve, Ibuprofen?.Y N If you are using Oral Contraceptives, it is important
Steroids (Cortisone, Prednisone, etc.)? .Y N that you understand that antibiotics (and some other medications) may interfere with the effectiveness of oral Insulin or Oral Anti-Diabetic drugs? .Y N contraceptives. Therefore, you will need to use Digitalis, Inderal, Nitroglycerin or other heart drug? Y N mechanical forms of birth control for one complete cycle of birth control pills, after the course of antibiotics or other medication is completed. Please consult with your physician for further guidance.
I understand the importance of a truthful and complete Health History to assist my dentist in providing the best care possible. I
have had the opportunity to discuss my Health History with my dentist.

Signature of Person Completing Health History

Source: http://www.omswebsites.com/clients/DrBrady/downloads/healthhistory.pdf

Informationen zur neuen grippe (influenza a/h1n1)

Informationen zur Neuen Grippe (Influenza A/H1N1) für Schulleitungen 1. Situationseinschätzung Deutschland Das Virus A/H1N1, das die Neue Grippe verursacht, kann leicht von Mensch zu Mensch übertragen werden. Das zeigt die ständig steigende Zahl der Erkrankten. Derzeit sind in Deutschland 16.835 Personen an der Neu-en Grippe erkrankt (Stand 04. September 2009). Die Mehrzahl d

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Robert Koch-Institut 119 Zum Umgang mit MRSA-Patienten in deutschen Krankenhäusern Ergebnisse einer Umfrage der DGKH und des BVÖGD im Herbst 2010 Im Oktober 2010 wurde von der DGKH (Deutsche Gesell-berücksichtigt worden. Wesentliche Unterschiede bei Be-schaft für Krankenhaushygiene) zusammen mit dem trachtung der Träger der Einrichtungen ließen sich nicht BVÖGD (Bundesverband der Ä

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