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Reset Standard Insurance Company Medical History Statement Medical Underwriting, 900 SW Fifth Avenue Portland OR 97204 DIRECTIONS FOR APPLYING FOR COVERAGE This form must be completed when Evidence

How to fill out medical history statement

How to fill out a medical history statement?

1. Begin by gathering all relevant medical documents and records, including past medical reports, laboratory results, and prescriptions.
2. Start the medical history statement by providing personal information such as your full name, date of birth, contact details, and social security number.
3. Include your insurance information, including the name of your insurance company, policy number, and contact information.
4. Provide a comprehensive overview of your medical history, including any chronic or ongoing medical conditions, past surgeries, and hospitalizations.
5. Detail any known allergies or adverse reactions to medications, foods, or other substances.
6. Indicate your current medications, including the name, dosage, frequency, and reason for each medication.
7. Include information about your lifestyle choices, such as smoking, alcohol consumption, and recreational drug use if applicable.
8. Describe any family history of significant medical conditions, such as heart disease, cancer, diabetes, or mental health disorders.
9. Mention any recent tests, screenings, or procedures you have undergone and their results.
10. It is important to be honest and accurate while filling out the medical history statement to ensure proper healthcare management and diagnosis.

Who needs a medical history statement?

1. Individuals seeking medical care or treatment from a healthcare provider.
2. Patients undergoing surgery or any invasive procedures.
3. Individuals applying for life insurance or disability insurance.
4. Students enrolling in schools, colleges, or universities, particularly those participating in sports or physical activities.
5. Job applicants in certain industries, especially those involving physical labor or hazardous conditions.
6. Individuals involved in legal proceedings where their medical history is relevant.
7. Emergency responders or paramedics who need to quickly assess a patient's medical condition.

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What is medical history statement?

The medical history statement is a form that documents an individual's past and present health conditions, treatments, and medications.

Who is required to file medical history statement?

Individuals who are applying for a new insurance policy or undergoing a medical examination may be required to file a medical history statement.

How to fill out medical history statement?

Individuals can fill out a medical history statement by providing detailed information about their medical history, including any past illnesses, surgeries, medications, and family medical history.

What is the purpose of medical history statement?

The purpose of a medical history statement is to provide insurers and healthcare providers with important information about an individual's health status, which can help determine eligibility for insurance coverage and inform medical treatment decisions.

What information must be reported on medical history statement?

Information that must be reported on a medical history statement typically includes past medical conditions, surgeries, hospitalizations, medications, allergies, family medical history, and lifestyle factors.