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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 Read the Information Practices Notice(s)
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How to fill out a medical history statement:

01
Gather all relevant medical documents and information: Before filling out a medical history statement, gather any medical records, prescriptions, and test results that you have. This will help ensure that you provide accurate and detailed information.
02
Start with personal details: Begin by filling out your personal details, such as your full name, date of birth, address, and contact information. This will help identify you as the patient.
03
Provide information about previous medical conditions: In the medical history statement, include any previous medical conditions you have been diagnosed with. This may include chronic illnesses, surgeries, hospitalizations, or any ongoing treatments you are receiving.
04
Mention current medications: List all the medications you are currently taking, including both prescription and over-the-counter drugs. Be sure to include the name of the medication, dosage, and frequency.
05
Include information about allergies: It is important to mention any allergies or adverse reactions you have had to medications, food, or other substances. This will help healthcare professionals avoid any potential complications.
06
Provide details about family medical history: Mention any significant medical conditions that run in your family, as these may have a genetic component. Include information about your parents, siblings, and any other close relatives.
07
Mention lifestyle factors: Include any lifestyle factors that may impact your health, such as smoking, alcohol consumption, exercise habits, and diet choices. This information can help healthcare professionals understand potential risk factors.
08
Be thorough and honest: When filling out a medical history statement, it is crucial to be thorough and honest. This information is important for healthcare professionals to provide you with appropriate and personalized care.

Who needs a medical history statement:

A medical history statement is often required by healthcare providers, hospitals, clinics, and insurance companies. It is essential for doctors to have a comprehensive understanding of your medical history to ensure accurate diagnosis and treatment. This statement helps healthcare professionals make informed decisions about your healthcare and reduces the risk of complications during procedures or treatments. Additionally, having a medical history statement can expedite the process of determining appropriate insurance coverage and potential exclusions based on pre-existing conditions.
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Medical history statement is a document that includes information about an individual's past medical conditions, treatments, surgeries, and medications.
Individuals who are applying for certain types of insurance or medical services may be required to fill out a medical history statement.
To fill out a medical history statement, the individual will need to provide accurate and detailed information about their medical history, including any pre-existing conditions, surgeries, medications, and treatments.
The purpose of a medical history statement is to provide healthcare providers or insurance companies with important information about an individual's health background, which can help them make informed decisions about treatment or coverage.
Information that must be reported on a medical history statement may include past medical conditions, surgeries, hospitalizations, medications, allergies, and family medical history.
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