Get the free Clinical History Sheet - Sentara.com

Clinical History Sheet Dorothy G. Hoofer Comprehensive Breast Center Providing world-class breast care for all generations Medical Information (please circle appropriate answer) Home Phone: Work Phone:

How to fill out clinical history sheet

How to fill out a clinical history sheet:

1. Start by providing personal information such as your full name, date of birth, and contact details.
2. Include any relevant medical history, including pre-existing conditions, surgeries, or allergies.
3. Document your family's medical history, noting any hereditary diseases or conditions.
4. Provide a detailed account of your current symptoms, including the onset, duration, and severity.
5. Include information about any medications or supplements you are currently taking.
6. List any previous treatments or therapies you have undergone related to your condition.
7. Mention any lifestyle factors that may be relevant, such as smoking, alcohol consumption, or exercise habits.
8. If applicable, provide information about your occupation and any potential occupational hazards.
9. Be sure to sign and date the document to indicate your consent and acknowledgement of the information provided.

Who needs a clinical history sheet:

1. Patients visiting a healthcare professional or institution for medical evaluation or treatment.
2. Individuals seeking a second opinion or transitioning to a new healthcare provider.
3. Medical researchers or institutions conducting studies or clinical trials.
4. Insurance companies or disability agencies assessing an individual's health status for coverage or benefits.
5. Legal professionals involved in medical malpractice or personal injury cases seeking medical records.
6. Emergency medical staff assessing and treating patients in urgent situations.
7. Medical students or healthcare professionals in training who need to review a patient's medical history.

For pdfFiller’s FAQs

What is clinical history sheet?

Clinical history sheet is a form or document that contains relevant medical and personal information about a patient, including their medical conditions, past treatments, allergies, medications, and family medical history.

Who is required to file clinical history sheet?

Clinical history sheet is typically filed by healthcare professionals, such as doctors, nurses, or medical assistants, who are responsible for documenting and maintaining the patient's medical records.

How to fill out clinical history sheet?

To fill out a clinical history sheet, healthcare professionals need to gather relevant information from the patient, such as their medical conditions, past treatments, allergies, medications, and family medical history. They can then document this information in the appropriate sections of the clinical history sheet.

What is the purpose of clinical history sheet?

The purpose of a clinical history sheet is to provide a comprehensive and organized record of a patient's medical and personal information. It serves as a valuable resource for healthcare professionals in diagnosing and treating the patient, as well as ensuring continuity of care.

What information must be reported on clinical history sheet?

The clinical history sheet typically includes information such as the patient's medical conditions, past treatments, allergies, medications, family medical history, demographic information, and any specific notes or observations made by healthcare professionals.

How do I edit clinical history sheet in Chrome?

Download and install the pdfFiller Google Chrome Extension to your browser to edit, fill out, and eSign your clinical history sheet, which you can open in the editor with a single click from a Google search page. Fillable documents may be executed from any internet-connected device without leaving Chrome.

Can I create an electronic signature for the clinical history sheet in Chrome?

Yes, you can. With pdfFiller, you not only get a feature-rich PDF editor and fillable form builder but a powerful e-signature solution that you can add directly to your Chrome browser. Using our extension, you can create your legally-binding eSignature by typing, drawing, or capturing a photo of your signature using your webcam. Choose whichever method you prefer and eSign your clinical history sheet in minutes.

Can I edit clinical history sheet on an iOS device?

You certainly can. You can quickly edit, distribute, and sign clinical history sheet on your iOS device with the pdfFiller mobile app. Purchase it from the Apple Store and install it in seconds. The program is free, but in order to purchase a subscription or activate a free trial, you must first establish an account.