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This document is a medical history and physical examination report required for students at the University of Notre Dame. It includes sections for personal information, immunization history, medical

How to fill out medical history physical report

How to fill out Medical History & Physical Report

1. Gather personal information such as name, date of birth, address, and contact details.
2. List all current medications, including dosage and frequency.
3. Note any known allergies to medications, foods, or environmental factors.
4. Detail past medical history, including surgeries, chronic illnesses, and hospitalizations.
5. Include family medical history to identify hereditary conditions.
6. Document lifestyle information such as smoking, alcohol use, and exercise habits.
7. Provide vaccination history.
8. Complete the physical exam section, detailing findings from assessments such as blood pressure, heart rate, and respiratory rate.
9. Review and sign the report to confirm that all information is accurate.

Who needs Medical History & Physical Report?

1. Individuals seeking a new job that requires a health clearance.
2. Students entering school or college who need a health evaluation.
3. Athletes required to submit a physical examination report.
4. Patients undergoing surgery or medical procedures.
5. Individuals applying for health insurance or life insurance.
6. People with chronic illnesses needing ongoing health assessments.

People Also Ask about

How to write history and physical examination?

The HPI should be written in prose with full sentences and be a narrative that builds an argument for the reason the patient was admitted. ​ Has a starting point (i.e. “the patient was in her usual state of health until 5 days prior to admission.). ​ Has appropriate flow, continuity, sequence, and chronologic order.

What is included in a patient's history and physical?

The history component of an H&P gathers relevant information about the patient's history with their current chief complaint. This includes reviewing any pre-existing conditions, past hospitalizations and surgeries, allergies, medications being taken, and family medical history.

What is considered your medical history?

There are three types of medical records commonly used by patients and doctors: Personal health record (PHR) Electronic medical record (EMR) Electronic health record (EHR)

What are three types of medical records?

Patient age. diagnoses, the type and number of surgeries and procedures scheduled to be performed, comorbidities, and the level of anesthesia required for the surgery or procedure.

What is history and Physical in medical records?

A record of information about a person's health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise.

What is medical records history and physical?

The H&P: History and Physical is the most formal and complete assessment of the patient and the problem. H&P is shorthand for the formal document that physicians produce through the interview with the patient, the physical exam, and the summary of the testing either obtained or pending.

What are examples of medical history?

Please list any past medical history below with date of onset or diagnosis. Examples include asthma, diabetes, depression, anxiety, drug or alcohol dependency, high blood pressure, thyroid disease, autoimmune disease, chronic pain, gynecologic disorder. Have you ever had surgery?

For pdfFiller’s FAQs

What is Medical History & Physical Report?

A Medical History & Physical Report is a document that provides a comprehensive overview of a patient's medical history and details of physical examinations conducted by healthcare professionals.

Who is required to file Medical History & Physical Report?

Typically, healthcare providers, such as doctors and nurses, are required to file a Medical History & Physical Report for patients undergoing certain procedures, admissions to healthcare facilities, or as part of routine medical evaluations.

How to fill out Medical History & Physical Report?

To fill out a Medical History & Physical Report, a healthcare provider collects patient information regarding past medical conditions, surgeries, medications, allergies, family medical history, and findings from the physical examination. All sections must be completed accurately.

What is the purpose of Medical History & Physical Report?

The purpose of a Medical History & Physical Report is to document a patient's medical background and assess their current health status to guide diagnosis, treatment, and continuity of care.

What information must be reported on Medical History & Physical Report?

The report must include information such as the patient's personal details, past medical history, medications, allergies, family history, social history, and the results of the physical examination.