ANUBHA SINHA, M.D. Hunterdon Digestive Health Specialist
Location 1: 170 Route 31 Flemington, NJ 08822
Patient Health Questionnaire Please fill out as much as possible to help with your medical care. Use the back of the sheet if you run out space. For medications, please include the dosage. Date: ___________ Patient Name: ________________________________________ Date of Birth: _____/_____/_____ Marital Status: _________ Primary Doctor: _____________________________________________ Referring provider: ___________________________________________ **REASON FOR VISIT: ** _______________________________________ Past/Present Gastrointestinal Illnesses (Please circle) Anemia Diverticulitis Hepatitis B Diverticulosis Hepatitis C Duodenal Ulcer Irritable Bowel Syndrome Cirrhosis of the Liver Fatty Liver Lactose Intolerance Gallstones Pancreatitis Colon Cancer Gastric Cancer Colon Polyps Gastric Polyp Stomach Ulcer Chron’s Disease H. Pylori Ulcerative Colitis Depression Hepatitis A Do you Smoke? Yes / No **If yes, how many packs per week? __________ Do you Drink Caffeine? Yes / No **If yes, how many drinks per week? ________ Do you Drink Alcohol? Yes / No **If yes, how many drinks per week? ________ Past Surgeries (Examples: Heart bypass, appendectomy etc) Medication Allergies OR LATEX(please state drug and the reaction) Medications (please include all medications including over the counter medicines. Include dosing information) Medication frequency *Are you on blood thinners? IE Coumidin, Lovenox, Aspirin, Plavix, or Other.
Do you have a history of endocarditis or artificial heart valve? Yes / No
Do you have a pacemaker? Yes / No If yes, Cardiologist
Do you have a history of kidney problems? Yes / No Do you have any other serious medical problems for which you currently being treated? Yes / No Family History (any stomach, colon, liver disease or cancer) Please Circle Colitis Heart Trouble Colon Cancer Liver Cancer Colon Polyps Liver Disease Chron’s Disease Pancreatic Cancer Esophageal Cancer Stomach Cancer Gall Bladder Disease Ulcer Disease OTHER__________ Review of Systems: Please circle any symptoms that you currently have or have suffered from in the past. General Weight loss Gastrointestinal: Heartburn Cardiovascular: Chest pain Pulmonary: Chronic cough Skin: Rash Musculoskeletal: Joint pains/swelling Stiff joints Back pain Sciatica Ears, Nose and Throat: Hearing loss
SUSANE - Sustainable, sanitary and efficient management of animal manure for plant nutrition Impact of medicated feed on the development of antimicrobial resistant bacteria in integrated pig-fish farms in Vietnam. 1. Introduction Use of animal manure as fertilizer of aquaculture ponds is practiced widely in Southeast Asia. Pigs are raised in houses on the edge of ponds and
Prévention des infections de l’hiver ’est au moment où l’automne est encore beau, mais quand les nuits deviennent fraiches, qu’il faut adopter une stratégie pour se prémunir des infections de l’hiver. Les risques sont là, et si nos C défenses immunitaires sont affaiblies, les premiers « coups de froid » vont se transformer en rhumes, maux de gorge, irritation de la t