Treatment History Sample Clauses

Treatment History. Document the history of all treatment past and present:
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Treatment History. List below all professional and/or personal efforts that have been made to address your son/daughter’s emotional, behavioral, or substance abuse problems (i.e., therapy, hospitalizations, treatment programs, placement, etc.). List the most current treatment first; include addresses and telephone numbers. Add additional sheets if needed. Intervention 1: Reason: Professional/Therapist: Credentials: Address: Telephone: ( ) Your assessment of treatment outcome: Intervention 2: Reason: Professional/Therapist: _ Credentials: Address: Telephone: ( ) Your assessment of treatment outcome: Intervention 3: Reason: Professional/Therapist: Credentials: Address: Telephone: ( ) Your assessment of treatment outcome: Intervention 4: Reason: Professional/Therapist: Credentials: Address: Telephone: ( ) Your assessment of treatment outcome: _ Name of Person completing this form (Printed Name): Signature of person completing this form: MEDICAL HISTORY Participant’s name: Person completing form and relation:
Sample 1
Treatment History. If you do not have back or low back pain, skip this section and go to “past medical history” section) Which of the following caregivers have you visited prior to your arrival here? (Please provide names) □ Family Physicians (includes general practitioners, Internists, gynecologists, etc.) □ Orthopedic Surgeon □ Neurologist □ Rheumatologist □ Chiropractor □ Acupuncturist □ Physical Therapy □ Other Pain Management Which of the following test(s) have you undergone prior to your arrival today? □ X-Rays □ CAT Scan □ MRI Scan □ EMG test □ Discogram □ Neural Block □ Myelogram Have you had any of the following interventions done for your neck or low back pain? □ Trigger Point Injections □ Ultrasound □ Heat □ Cold □ Cryotherapy □ TENS/ nerve stimulator □ Discography □ Facet □ Sacroiliac □ Other Joint injections Have you ever had any of the following surgical interventions (for neck and back pain)? □ Back Surgery: fusion Date: _ □ Back Surgery: non-fusion Date: _ □ Back Surgery: Spinal Cord Stimulator Date: _ List all Surgeries and their DATES: PATIENT HISTORY Please list all, if any DRUG ALLERGIES and their REACTIONS: Do you take any of the following? □ Aspirin □ Coumadin □ Plavix □ Heparin □ Pletal □ Lovenox □ Ticlid □ Effient Please list all MEDICATIONS CURRENT MEDICATIONS DOSAGE HOW OFTEN
Sample 1

Related to Treatment History

  • Treatment The Asset Representations Reviewer agrees to hold and treat Confidential Information given to it under this Agreement in confidence and under the terms and conditions of this Section 4.08, and will implement and maintain safeguards to further assure the confidentiality of the Confidential Information. The Confidential Information will not, without the prior consent of the Issuer and the Servicer, be disclosed or used by the Asset Representations Reviewer, or its officers, directors, employees, agents, representatives or affiliates, including legal counsel (collectively, the “Information Recipients”) other than for the purposes of performing Reviews of Review Receivables or performing its obligations under this Agreement. The Asset Representations Reviewer agrees that it will not, and will cause its Affiliates to not (i) purchase or sell securities issued by the Seller or its Affiliates or special purpose entities on the basis of Confidential Information or (ii) use the Confidential Information for the preparation of research reports, newsletters or other publications or similar communications.

  • Xxx Treatment We have not promised you any particular tax outcome from buying or holding the Note.

  • Fair Treatment The College and the Union agree that there shall be no discrimination, restriction, or coercion exercised or practised with respect to any employee for reason of membership or activity in the Union.

  • Substance Abuse Treatment Information Substance abuse treatment information shall be maintained in compliance with 42 C.F.R. Part 2 if the Party or subcontractor(s) are Part 2 covered programs, or if substance abuse treatment information is received from a Part 2 covered program by the Party or subcontractor(s).

  • TREATMENT PLANS Within a reasonable period of time after the initiation of treatment, Xxxxxxxxx Xxxxx will discuss with you her working understanding of the problem, treatment plan, therapeutic objectives, and her view of the possible outcomes of treatment. If you have any unanswered questions about any of the procedures used in the course of your therapy, their possible risks, Xxxxxxxxx Xxxxx 's expertise in employing them, or about the treatment plan, please ask and you will be answered fully. You also have the right to ask about other treatments for your condition and their risks and benefits.

  • Protection, Treatment (1) Each Contracting Party shall protect within its State territory investments made in accordance with its national laws and regulations by investors of the other Contracting Party and shall not impair by unreasonable or discriminatory measures the management, maintenance, use, enjoyment, extension, sale or liquidation of such investments. In particular, each Contracting Party or its competent authorities shall issue the necessary authorisations mentioned in Article 2, paragraph (2) of this Agreement.

  • Emergency Medical Treatment I grant the Releasees permission to authorize emergency medical treatment as they deem appropriate, and agree that such action by the Releasees shall be subject to the terms of this Agreement. I understand and agree that the Releasees assume no responsibility for any injury or damage that might result from such emergency medical treatment.

  • Treatment Program Testing The Employer may request or require an employee to undergo drug and alcohol testing if the employee has been referred by the employer for chemical dependency treatment or evaluation or is participating in a chemical dependency treatment program under an employee benefit plan, in which case the employee may be requested or required to undergo drug or alcohol testing without prior notice during the evaluation or treatment period and for a period of up to two years following completion of any prescribed chemical dependency treatment program.

  • Treatment of Client Property Unless otherwise provided, the Contractor shall ensure that any adult client receiving services from the Contractor has unrestricted access to the client’s personal property. The Contractor shall not interfere with any adult client’s ownership, possession, or use of the client’s property. The Contractor shall provide clients under age eighteen (18) with reasonable access to their personal property that is appropriate to the client’s age, development, and needs. Upon termination of services to a client, the Contractor shall immediately release to the client and/or the client’s guardian or custodian all of the client’s personal property.

  • National Treatment and Most-favoured-nation Treatment (1) Each Contracting Party shall accord to investments of investors of the other Contracting Party, treatment which shall not be less favourable than that accorded either to investments of its own or investments of investors of any third State.

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