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MEDICAL HISTORY AND PHYSICAL Parent should complete this side of form PRIOR to appointment with physician STUDENT NAME DATE OF BIRTH GRADE for school year 2016 2017 PARENT/GUARDIAN NAME ADDRESS PHONE

How to fill out medical history and physical

How to fill out medical history and physical

1. To fill out a medical history and physical form, follow these steps:
2. Begin by entering your personal information, including your full name, date of birth, and contact details.
3. Provide your medical insurance information, if applicable.
4. Mention any current medications you are taking, along with their dosage and frequency.
5. Describe your medical history, including any past surgeries, illnesses, or chronic conditions.
6. List any known allergies or adverse reactions to medications.
7. Provide information about your family medical history, such as any hereditary diseases or conditions.
8. Mention any lifestyle habits that may impact your health, such as smoking or alcohol consumption.
9. Answer the questions regarding your overall health, including any symptoms or concerns you may have.
10. If required, provide a detailed account of your past or current mental health conditions.
11. Review the form for completeness and accuracy before signing and submitting it.

Who needs medical history and physical?

1. A medical history and physical is typically required for the following individuals:
2. New patients visiting a healthcare provider for the first time.
3. Individuals seeking clearance for certain activities or jobs, such as sports participation or employment in physically demanding professions.
4. Patients scheduled for surgical procedures to assess their overall health and identify potential risks.
5. Individuals with complex medical conditions or chronic illnesses who require ongoing care.
6. People applying for certain types of insurance policies, as it helps insurers evaluate their level of risk.
7. Any individual who wishes to have a comprehensive record of their medical background for future reference.

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What is medical history and physical?

Medical history and physical is a document that provides information about a person's past health issues, current health status, and physical examination results.

Who is required to file medical history and physical?

Medical history and physical is typically required to be filed by individuals undergoing medical evaluations, such as new patients at a healthcare facility or individuals applying for certain jobs or programs.

How to fill out medical history and physical?

To fill out a medical history and physical form, individuals must provide accurate and detailed information about their medical history, current health conditions, allergies, medications, surgeries, and family health history. They may also need to undergo a physical examination conducted by a healthcare provider.

What is the purpose of medical history and physical?

The purpose of medical history and physical is to provide healthcare providers with essential information to make informed decisions about a person's health, diagnosis, treatment, and overall well-being.

What information must be reported on medical history and physical?

Information that must be reported on medical history and physical includes past and current medical conditions, surgeries, hospitalizations, medications, allergies, family history of diseases, lifestyle habits, and physical examination results.