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Reset State of New Mexico General Services Department Medical History Statement Standard Insurance Company Medical Underwriting, 900 SW Fifth Avenue Portland OR 97204 For Residents of: New Mexico
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How to fill out medical history statement
How to fill out a medical history statement:
01
Start by gathering all necessary information about your medical history, including any past illnesses, surgeries, and chronic conditions.
02
Fill in your personal information accurately, including your full name, date of birth, and contact information.
03
Provide details about your family medical history, such as any genetic diseases or hereditary conditions that run in your family.
04
Include information about your current medications, dosage, and frequency of use.
05
Answer any specific questions about allergies or reactions to medications, foods, or other substances.
06
Mention any known sensitivities or adverse reactions to anesthesia or any previous complications during medical procedures.
07
Describe any past or current mental health issues, such as depression, anxiety, or substance abuse.
08
Indicate whether you have any ongoing or past treatments, therapies, or rehabilitation programs.
09
Provide information about your lifestyle habits, such as smoking, alcohol or drug use, or regular exercise.
10
Ensure you sign and date the medical history statement to validate its accuracy.
Who needs a medical history statement?
01
Individuals seeking medical treatment or undergoing surgical procedures are typically required to complete a medical history statement.
02
Healthcare professionals, including doctors, nurses, and other medical staff, often request this document to evaluate a patient's overall health and identify any potential risks or complications.
03
Insurance companies may require a medical history statement when applying for coverage or processing claims to assess pre-existing conditions and associated risks.
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What is medical history statement?
Medical history statement is a document that details an individual's past and current health conditions, treatments, surgeries, and medications.
Who is required to file medical history statement?
Individuals applying for health insurance or seeking medical treatment may be required to file a medical history statement.
How to fill out medical history statement?
A medical history statement is typically filled out by providing information about past and current health conditions, surgeries, treatments, medications, and family history of illnesses.
What is the purpose of medical history statement?
The purpose of a medical history statement is to provide healthcare providers and insurance companies with important information about an individual's health to ensure proper care and coverage.
What information must be reported on medical history statement?
The information reported on a medical history statement may include past and current health conditions, surgeries, treatments, medications, and family history of illnesses.
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