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Standard Insurance Company Medical History Statement Medical Underwriting, 900 SW Fifth Avenue Portland OR 97204 For Residents of: Connecticut DIRECTIONS FOR APPLYING FOR COVERAGE Read the Information

How to fill out medical history statement

How to fill out medical history statement

1. Gather all relevant medical information and records.
2. Start by filling in your personal information like name, date of birth, and contact details.
3. Provide a detailed account of your medical history, including any previous illnesses, surgeries, or hospitalizations.
4. Include information about any medications you are currently taking or have taken in the past.
5. Mention any allergies or adverse reactions to medications.
6. Provide information about your family medical history, including any hereditary conditions.
7. Answer questions related to your lifestyle, such as smoking or alcohol consumption.
8. If applicable, include information about your reproductive health and any pregnancies or miscarriages.
9. Make sure to sign and date the medical history statement after completing it.

Who needs medical history statement?

1. Anyone seeking medical care or treatment.
2. Patients visiting a new healthcare provider.
3. Individuals participating in clinical trials or research studies.
4. Candidates for certain jobs or occupations that require medical clearance.
5. Individuals applying for insurance policies.
6. People planning to undergo major surgeries or procedures.

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What is medical history statement?

A medical history statement is a document that contains a person's past medical conditions, treatments, surgeries, and family medical history.

Who is required to file medical history statement?

Individuals applying for certain insurance policies or undergoing medical examinations may be required to file a medical history statement.

How to fill out medical history statement?

To fill out a medical history statement, one must provide accurate information about their medical history, including past conditions, treatments, surgeries, and family medical history.

What is the purpose of medical history statement?

The purpose of a medical history statement is to provide insurance companies or medical professionals with information about an individual's past medical conditions to assess risk or provide appropriate care.

What information must be reported on medical history statement?

Information such as past medical conditions, treatments, surgeries, medications, and family medical history must be reported on a medical history statement.