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Patient Health and Social History Patient Name (First) (Middle) Birth Date Gender Male Female (Last) Today's Date Name of person filling out form (if not patient) Do you need an interpreter to assist

How to fill out borgess-geriatric-assessment-center-patient-health-history-formpdf

How to fill out borgess-geriatric-assessment-center-patient-health-history-formpdf?

1. Begin by carefully reading the form to understand what information is being asked for. Familiarize yourself with the different sections and categories.
2. Start with the patient's personal information section. Fill in details like the patient's name, address, phone number, and date of birth accurately.
3. Move on to the medical history section. Here, provide information about any pre-existing medical conditions the patient has, such as heart disease, diabetes, or high blood pressure. Include details about any surgeries, hospitalizations, or major illnesses they have experienced.
4. In the medication section, list all current medications the patient is taking, including over-the-counter drugs, vitamins, and supplements. Be sure to include the dosage and frequency of each medication.
5. The allergies section is important to fill out accurately. Indicate any known allergies the patient has, especially to medications, food, or environmental factors.
6. Next, provide details about the patient's family medical history. Include information about any significant health conditions that run in the family, such as cancer, heart disease, or diabetes.
7. If the form asks for lifestyle or social history, provide information about the patient's habits, like smoking or alcohol consumption. Include any relevant information about their daily activities or occupation.
8. If there is a section for emergency contacts, provide the names and phone numbers of individuals who can be reached in case of an emergency.
9. Carefully review the completed form to ensure all information has been filled out correctly and accurately.
10. Sign and date the form, if required.
11. Make copies of the filled-out form for your records, if necessary.

Who needs borgess-geriatric-assessment-center-patient-health-history-formpdf?

1. Older adults seeking comprehensive medical assessments and geriatric care.
2. Patients who are scheduled for appointments or consultations at the Borgess Geriatric Assessment Center.
3. Caregivers or family members assisting elderly individuals in completing their health history forms.
4. Healthcare professionals who require patients' detailed health history for accurate diagnosis and treatment planning in a geriatric setting.

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