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Waukesha County Health Department Medical History and Consent to Receive Novel H1N1 Influenza Vaccine 9468 PLEASE PRINT CLEARLY Part I. Personal Information for Person to Receive Vaccine First Name

How to fill out medical history and consent

How to fill out medical history and consent:

1. Start by carefully reading through the medical history and consent forms provided to you. Make sure you understand all the questions and terms.
2. Begin by providing your personal information accurately, including your full name, date of birth, address, and contact details.
3. Next, answer the questions regarding your medical history. Be thorough and honest, including any past or current medical conditions, surgeries, allergies, medications, and family medical history.
4. If you are unsure about any question or need clarification, don't hesitate to ask a healthcare professional for assistance.
5. After completing the medical history section, move on to the consent section. This will involve giving your permission for medical procedures, treatments, and sharing of medical information as required.
6. Read and understand the consent statements carefully before signing. If you have any concerns or questions about specific consent statements, seek clarification from a healthcare professional.
7. Once you are confident that you have provided accurate information and understood the consent statements, sign and date the forms as required.
8. Keep a copy of the filled-out forms for your records, and submit the originals to the appropriate healthcare provider or facility.

Who needs medical history and consent:

1. Any individual seeking medical care or treatment may be required to provide their medical history and consent.
2. This includes new patients visiting a healthcare provider for the first time as well as existing patients undergoing a new procedure or starting a new treatment.
3. Medical history and consent forms are essential for healthcare professionals to understand a patient's medical background, make informed decisions about their care, and ensure patient safety.
4. Consent forms also protect the rights and privacy of patients by obtaining their explicit permission for certain medical procedures and sharing of healthcare information.

Remember, always consult with a healthcare professional or follow specific instructions provided by your healthcare provider when filling out medical history and consent forms.

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What is medical history and consent?

Medical history and consent are forms that provide information about a patient's medical background and give permission for medical treatment to be administered.

Who is required to file medical history and consent?

Any individual receiving medical treatment is required to fill out and file medical history and consent forms.

How to fill out medical history and consent?

Medical history and consent forms can be filled out by providing accurate information about one's medical background and signing the consent section.

What is the purpose of medical history and consent?

The purpose of medical history and consent forms is to ensure that healthcare providers have necessary information and permission to provide appropriate treatment.

What information must be reported on medical history and consent?

Medical history forms typically require information such as past illnesses, surgeries, medications, allergies, and family medical history. Consent forms require agreement to receive treatment.