SECTION 1
Questions 1-10
Complete the notes below.
Write ONE WORD AND/OR A NUMBER for each answer.
TOTAL HEALTH CLINIC
PATIENT DETAILS
Personal information
Example
Name Julie Anne ……Garcia…..
Contact phone 1…………………
Date of birth 2…………………, 1992
Occupation works as a 3………………….
Insurance company 4…………………. Life Insurance
Details of the problem
Type of problem pain in her left 5…………………..
When it began 6…………………. ago
Action already taken has taken painkillers and applied ice
Other information
Sports played belongs to a 7…………………. club
goes 8…………………. Regularly
Medical history injured her 9………………… last year
no allergies
no regular medication apart from 10………………..