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HOUSTON CONFERENCE THE UNITED METHODIST CHURCH MEDICAL REPORT OF MINISTERIAL CANDIDATE Part I: MEDICAL HISTORY REPORT To be completed by the Candidate Name: Date of Birth: Address: Marital Status:
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How to fill out part I medical history:

01
Start by providing your personal information, such as your full name, date of birth, and contact details.
02
Next, mention any previous medical conditions or illnesses you have had in the past. Include the dates and details of these conditions.
03
Indicate any allergies or sensitivities you have, including medication allergies, food allergies, or environmental allergies.
04
Provide information about any medications you are currently taking, including the dosage and frequency.
05
Mention any surgeries or medical procedures you have undergone in the past. Include the dates and details of these procedures.
06
Include a family medical history section, where you can specify if any immediate family members have had significant medical conditions.
07
Fill in any other relevant information, such as your immunization record, chronic illnesses, or ongoing medical treatments.
08
Sign and date the form to certify that the information provided is accurate and complete.

Who needs part I medical history:

01
Individuals visiting a new healthcare provider or hospital may be required to fill out part I medical history.
02
Patients attending a specialized medical clinic or seeking specific treatments may also need to complete this section.
03
Part I medical history is crucial for healthcare professionals to understand a patient's medical background, make informed decisions, and provide appropriate care.
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Part I medical history is a form used to gather information about an individual's medical past and current health status.
All individuals receiving medical treatment or care are required to fill out Part I medical history.
Part I medical history can be filled out by providing accurate information about medical conditions, medications, surgeries, and family medical history.
The purpose of Part I medical history is to assist healthcare providers in understanding a patient's medical background and make informed treatment decisions.
Information such as medical conditions, medications, surgeries, allergies, and family medical history must be reported on Part I medical history.
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