Get the free Patient Health History Form - eou

A comprehensive patient health history form used by the Eastern Oregon University Student Health Center to collect important medical, surgical, social, and family health history information from students.

How to fill out patient health history form

How to fill out Patient Health History Form

1. Begin with personal information: Enter the patient's full name, date of birth, address, and contact information.
2. Fill in insurance details: Provide information regarding the patient's health insurance provider and policy number.
3. List medical history: Include any past illnesses, surgeries, or hospitalizations the patient has experienced.
4. Note family history: Document any significant health issues within the patient's family, such as heart disease, diabetes, or cancer.
5. Detail current medications: List all medications the patient is currently taking, including dosage and frequency.
6. Record allergies: Note any known allergies or adverse reactions to medications or substances.
7. Include lifestyle information: Share details about the patient's lifestyle, such as smoking, alcohol consumption, and exercise habits.
8. Provide additional notes: Allow space for any other relevant health information or concerns the patient may want to share.

Who needs Patient Health History Form?

1. Individuals seeking medical treatment or care.
2. Healthcare providers needing comprehensive patient information.
3. Patients undergoing a new medical evaluation or consultation.
4. Insurance companies requiring health history for coverage assessment.

People Also Ask about

How do I get a health history form?

How you make your request will depend on your provider's processes. You may be able to request your record through your provider's patient portal. You may have to fill out a form — called a health or medical record release form, or request for access — send an email, or mail or fax a letter to your provider.

Can you look up your medical history online?

Online Access to Your Health Information Check with your health care providers or doctors to see if they offer online access to your medical records. Terms sometimes used to describe electronic access to these data include “personal health record,” or “PHR,” or “patient portal.”

How to obtain health history?

Section 123110 of the Health & Safety Code specifically provides that any adult patient, or any minor patient who by law can consent to medical treatment (or certain patient representatives), is entitled to inspect patient records upon written request to a physician and upon payment of reasonable clerical costs to make

What is a general health history form?

A health history is part of the Assessment phase of the nursing process. It consists of using directed, focused interview questions and open-ended questions to obtain symptoms and perceptions from the patient about their illnesses, functioning, and life processes.

What is a typical medical history form?

A typical medical history form covers the essentials of a patient's health background, including: Past and current medical conditions. Surgeries and hospitalizations. Medications and allergies.

How do you take a full patient history?

Create a Checklist Greet patients and introduce yourself. Ask why the patient is being seen. Inquire about previous medical and surgical history. Ask about allergies and current medications. Request information about family medical history. Ask about social history, as well as smoking and drinking.

How to get a health history form?

How you make your request will depend on your provider's processes. You may be able to request your record through your provider's patient portal. You may have to fill out a form — called a health or medical record release form, or request for access — send an email, or mail or fax a letter to your provider.

How to write a patient's medical history?

2.3. COMPONENTS OF A HEALTH HISTORY Demographic and biological data. Reason for seeking health care. Current and past medical history. Family health history. Functional health and activities of daily living. Review of body systems.

For pdfFiller’s FAQs

What is Patient Health History Form?

The Patient Health History Form is a document that collects comprehensive information about a patient's medical history, including previous illnesses, surgeries, medications, and family health history.

Who is required to file Patient Health History Form?

Typically, all new patients are required to fill out the Patient Health History Form, and returning patients may need to update their information periodically.

How to fill out Patient Health History Form?

To fill out the Patient Health History Form, patients should provide accurate and complete information regarding their past medical history, current medications, allergies, family history, and any other relevant health details.

What is the purpose of Patient Health History Form?

The purpose of the Patient Health History Form is to help healthcare providers understand the patient's medical background in order to provide safe and effective care.

What information must be reported on Patient Health History Form?

Patients must report information such as personal medical history, surgical history, current medications, allergies, family health history, lifestyle factors (like smoking or alcohol use), and any ongoing treatments or conditions.