Get the free Medical History Statement - University of Colorado - cu

Reset University of Colorado Class?ed Staff Medical History Statement Standard Insurance Company Medical Underwriting, 900 SW Fifth Avenue Portland OR 97204 DIRECTIONS FOR APPLYING FOR COVERAGE Read

How to fill out medical history statement

How to fill out a medical history statement?

1. Begin by reading the instructions: Before you start filling out the medical history statement, carefully read the provided instructions. Understand the purpose of the form and the specific information it requires.
2. Gather necessary documents: Collect any relevant documents or records that can help you accurately fill out the medical history statement. This may include past medical records, prescriptions, and allergy lists.
3. Provide personal information: Start by filling out your personal details such as your full name, date of birth, address, and contact information. This ensures that your medical history is correctly attributed to you.
4. Include emergency contacts: Provide the names and contact information of at least two emergency contacts who can be reached in case of any medical emergencies.
5. Record medical conditions: Carefully list any current or past medical conditions you have experienced. This may involve chronic illnesses, surgeries, or significant injuries. Be sure to include dates and any additional information that can help medical professionals understand your medical background.
6. Mention medications: List all the medications you are currently taking, including prescriptions, over-the-counter drugs, supplements, and herbal remedies. Specify the dosage and frequency of each medication. This information helps medical personnel ensure proper treatment and avoid any potential drug interactions.
7. Report allergies: Indicate any known allergies or adverse reactions you have experienced in the past, whether related to medications, food, or environmental factors. Allergies can significantly impact medical treatment, so providing accurate information is crucial.
8. Include family medical history: Document any known hereditary or familial medical conditions that run in your family. This may include diseases like diabetes, heart conditions, cancer, or any conditions that may have a genetic component.

Who needs a medical history statement?

A medical history statement is typically required by healthcare professionals or organizations to gather comprehensive information about a patient's health background. It is necessary for various scenarios such as:

1. New patients visiting a healthcare provider: When you visit a new doctor, specialist, or clinic, they may require you to fill out a medical history statement. It helps them understand your medical background, provide appropriate care, and make informed decisions.
2. Hospital admissions: If you are admitted to a hospital for surgery, treatments, or specific procedures, a medical history statement is often part of the admission process. It enables medical staff to be aware of any pre-existing conditions or factors that could affect your treatment plan.
3. Insurance applications: Some insurance providers require a medical history statement as part of the application process. This allows them to assess your health status and determine coverage options and premiums accurately.
4. Participation in certain activities: People who engage in certain activities, such as sports, physical competitions, or volunteer work, may be required to submit a medical history statement. This ensures that organizers and supervisors are aware of any health conditions that may affect participation or require special attention.

Remember, providing accurate and complete information in your medical history statement is crucial for receiving appropriate medical care and ensuring your health and safety.

For pdfFiller’s FAQs

What is medical history statement?

Medical history statement is a document that contains information about an individual's past and present medical conditions, treatments, and medications.

Who is required to file medical history statement?

Individuals who are applying for certain jobs or insurance policies may be required to file a medical history statement.

How to fill out medical history statement?

To fill out a medical history statement, individuals must provide accurate and detailed information about their medical history, including any past illnesses, surgeries, medications, and treatments.

What is the purpose of medical history statement?

The purpose of a medical history statement is to provide healthcare providers or insurers with important information about an individual's health status and medical needs.

What information must be reported on medical history statement?

Information that must be reported on a medical history statement typically includes past and current medical conditions, treatments, medications, surgeries, allergies, and family medical history.

How do I make changes in medical history statement?

pdfFiller not only lets you change the content of your files, but you can also change the number and order of pages. Upload your medical history statement to the editor and make any changes in a few clicks. The editor lets you black out, type, and erase text in PDFs. You can also add images, sticky notes, and text boxes, as well as many other things.

Can I create an electronic signature for the medical history statement in Chrome?

Yes, you can. With pdfFiller, you not only get a feature-rich PDF editor and fillable form builder but a powerful e-signature solution that you can add directly to your Chrome browser. Using our extension, you can create your legally-binding eSignature by typing, drawing, or capturing a photo of your signature using your webcam. Choose whichever method you prefer and eSign your medical history statement in minutes.

How can I edit medical history statement on a smartphone?

The pdfFiller mobile applications for iOS and Android are the easiest way to edit documents on the go. You may get them from the Apple Store and Google Play. More info about the applications here. Install and log in to edit medical history statement.