Get the free Patient History Form - Healthcare OHSU

Name Date Patient History Form New patients and return patients with last exam 1 year ago The doctor or person who referred you: Name: Address: Why did you come to see us today? (check all that apply)

How to fill out patient history form

How to fill out patient history form:

1. Start by providing your personal information such as your name, date of birth, and contact details. This will help the healthcare provider identify you correctly and reach you if needed.
2. Mention any allergies or sensitivities you may have to medications, foods, or other substances. This information is crucial for avoiding any adverse reactions during your healthcare treatment.
3. Detail your medical history, including any past and current illnesses, surgeries, or hospitalizations. Include information about chronic conditions you may have, such as diabetes or high blood pressure.
4. Provide a list of medications you are currently taking, including prescription drugs, over-the-counter medications, and any supplements. This will help the healthcare provider assess any potential drug interactions or side effects.
5. Mention any lifestyle habits or behaviors that may impact your health, such as smoking, alcohol consumption, or recreational drug use. This information can aid the healthcare provider in providing appropriate advice or interventions.
6. Describe any known family medical history, particularly if there are any genetic conditions or diseases that run in your family. This helps to identify potential hereditary risks and allows for preventive measures.

Who needs a patient history form:

1. Patients visiting a healthcare provider for the first time will typically be asked to fill out a patient history form. This form helps the healthcare provider gather relevant information about the patient's medical background and current health status.
2. Patients undergoing specific medical procedures or treatments may also be required to fill out a patient history form. This ensures that the healthcare team has a comprehensive understanding of the patient's health condition before proceeding with the procedure or treatment.
3. By having a patient history form, healthcare providers can maintain accurate and up-to-date records for each patient. This allows for proper continuity of care and helps healthcare professionals make informed decisions regarding diagnosis, treatment, and overall patient care.

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What is patient history form?

The patient history form is a document that collects information about a patient's medical history, previous illnesses, treatments, medications, and any allergies.

Who is required to file patient history form?

Patients or their guardians are typically required to fill out and file the patient history form.

How to fill out patient history form?

Patients can fill out the patient history form by providing accurate and detailed information about their medical history, previous illnesses, medications, treatments, and any allergies.

What is the purpose of patient history form?

The purpose of the patient history form is to provide healthcare providers with important information about a patient's medical background, which can help in diagnosing and treating any current medical issues.

What information must be reported on patient history form?

Information such as medical history, previous illnesses, medications, treatments, allergies, and any other relevant medical information must be reported on the patient history form.