English to Spanish Medical Medical (general) Family Medicine

MEDICARE INITIAL PREVENTIVE PHYSICAL EXAMINATION ENCOUNTER FORM (“WELCOME TO MEDICARE PHYSICAL”)

Patient’s name: ________________________________________________ Date of birth: ___________________ Medical record #: ______________________ Medicare B eligibility date: ___________________________________ Date of exam: ___________________ Date of last exam: _____________________ Medical/social history
Past personal injury or illness/surgery Date Hospitalized? Drug allergies: __________________________________
and it continues with questions about Social history, Family history, etc.

Would this be a FORMULARIO DE CONTACTO INICIAL or FORMULARIO DE VERIFICACION?
I'm totally lost on 'ENCOUNTER"
Gracias de anticipado por su ayuda.