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Your Personal Health Record Remember to take this record with you to all of your medical appointments and hospitalizations This material prepared by Dr. Eric Coleman, UC HSC, CPR, and funded by the

How to fill out your personal health record

How to fill out your personal health record:

1. Gather all relevant medical documents: Start by collecting any existing medical documents such as medical history, test results, and prescription records. This will provide a comprehensive overview of your health.
2. Include personal information: Write down your full name, date of birth, contact information, and emergency contact details. It is essential to update this information regularly to ensure the accuracy of your personal health record.
3. Record your medical history: Write a detailed account of your medical conditions, surgeries, hospitalizations, allergies, and chronic illnesses. Include relevant dates and treatment information alongside each entry.
4. Document current medications: Make a list of all the medications you are currently taking, including prescription drugs, over-the-counter medications, vitamins, and supplements. Note down the dosage, frequency, and any specific instructions given by your healthcare provider.
5. List healthcare providers: Include the contact information of your primary care physician, specialists, and any other healthcare professionals involved in your care. Mention the purpose of each visit or consultation, as this will help create a comprehensive medical history.
6. Record vaccinations and immunizations: Include a complete record of your vaccinations and immunizations, including the dates of administration. This will help you stay up to date with any necessary boosters or vaccines.
7. Update your family medical history: Document any illnesses or medical conditions that run in your family, as this information can be crucial for identifying potential hereditary diseases.
8. Track your vital signs: Regularly record your blood pressure, heart rate, weight, and other relevant vital signs. This data will help both you and your healthcare provider monitor any trends or changes over time.
9. Keep your personal health record secure: Ensure that your personal health record is stored in a secure and easily accessible location. Consider using digital tools or online platforms that offer encryption and password protection for added security.

Who needs your personal health record?

1. You: Keeping an up-to-date and comprehensive personal health record empowers you to actively participate in your healthcare decisions. It allows you to have a clear understanding of your medical history, medications, and treatment plans.
2. Healthcare providers: Your personal health record provides essential information to healthcare providers, enabling them to make well-informed decisions regarding your care. It serves as a valuable reference during consultations, emergencies, and when coordinating care across different providers.
3. Emergency responders: In the event of an emergency, emergency responders may need access to your personal health record to quickly understand your medical conditions, allergies, and previous treatments. This can help them provide appropriate and timely care.
4. Family members and caregivers: Sharing your personal health record with trusted family members or caregivers ensures that they are aware of your medical history, medications, and any specific instructions you may have. This can assist them in supporting your healthcare needs effectively.
5. Health insurance providers: Health insurance providers may request access to your personal health record for various purposes, such as verifying claims, assessing eligibility for specific treatments, or processing pre-authorizations.

For pdfFiller’s FAQs

What is your personal health record?

Your personal health record is a record of your medical history, treatments, and important health information.

Who is required to file your personal health record?

You are required to file your personal health record with your healthcare provider or insurance company.

How to fill out your personal health record?

You can fill out your personal health record by providing accurate information about your medical history, medications, allergies, and any other relevant health information.

What is the purpose of your personal health record?

The purpose of your personal health record is to provide healthcare providers with important information about your health to ensure appropriate care.

What information must be reported on your personal health record?

Information such as your medical history, medications, allergies, surgeries, and contact information must be reported on your personal health record.

How can I modify your personal health record without leaving Google Drive?

Using pdfFiller with Google Docs allows you to create, amend, and sign documents straight from your Google Drive. The add-on turns your your personal health record into a dynamic fillable form that you can manage and eSign from anywhere.

How can I edit your personal health record on a smartphone?

The easiest way to edit documents on a mobile device is using pdfFiller’s mobile-native apps for iOS and Android. You can download those from the Apple Store and Google Play, respectively. You can learn more about the apps here. Install and log in to the application to start editing your personal health record.

How do I complete your personal health record on an iOS device?

Install the pdfFiller app on your iOS device to fill out papers. If you have a subscription to the service, create an account or log in to an existing one. After completing the registration process, upload your your personal health record. You may now use pdfFiller's advanced features, such as adding fillable fields and eSigning documents, and accessing them from any device, wherever you are.