Laserfiche WebLink
Page 1 of 1 <br /> Alfonso Arambula [EH] <br /> From: Alfonso Arambula [EH] <br /> Sent: Wednesday, December 18, 2013 2:04 PM <br /> To: 'Fawn Liang' <br /> Subject: Medical Questionnaire <br /> Attachments: Medical Questionnaire.pdf <br /> Hello Mrs. Fawn, <br /> Please make the changes noted below to the medical questionnaire. <br /> Change#1 so it reads—Are you currently using medication or do you have a history of medication use, including <br /> being prescribed antibiotics prior to dental or surgical procedures? <br /> Change#2 so it reads—Do you have a history of allergic reactions to latex or antibiotics? <br /> Change#9 so it reads— Do you have a history of cardiac valve disease or are you taking any heart medication? <br /> Change#10 so it reads—Do you have a history of herpes infection at the proposed procedure site? <br /> Add#13 so it reads—Do you have a history of hemophilia or other bleeding disorder? <br /> Add#14 so it reads—Are you pregnant? <br /> Alfonso Arambula, Sr REHS <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 E. Hazelton Ave Stockton, CA 95205 <br /> Email: aarambulaCc�sicehd.com (209)468-9673 <br /> EHD Website: http://www.so og v org/ehd Fax(209)468-8392 <br /> 1/6/2014 <br />