Get the free Medical History and Physical Examination Form - West Deptford ...

West Dept ford Township Public Schools 675 Grove Road, Suite 804 ? West DEP ORD NJ 08066?1999 Phone (856) 848?4300 ? Fax (856) 845?5743 www.wdeptford.k12.nj.us MEDICAL HISTORY & PHYSICAL EXAMINATION

How to fill out medical history and physical

Point by point instructions on how to fill out a medical history and physical form:

1. Start by providing your personal information. This includes your full name, date of birth, address, phone number, and emergency contact details. These details are crucial for healthcare providers to accurately identify and reach out to you if needed.
2. Next, disclose your medical history. Begin by outlining any previous illnesses, surgeries, or hospitalizations you have undergone. It is important to mention any chronic conditions you may have, such as diabetes, asthma, or heart disease. Be sure to include any allergies or adverse reactions to medications as well.
3. Provide a thorough account of your current medications. List all prescription drugs, over-the-counter medications, vitamins, and supplements you are currently taking. Include the dosage and frequency of each medication. This information helps healthcare providers determine possible drug interactions or side effects.
4. Describe your family medical history. Indicate if any close family members have had significant health conditions, such as cancer, heart disease, or diabetes. This information is valuable as certain conditions may have a genetic component or predisposition.
5. Outline your lifestyle habits. Mention any tobacco or alcohol use, as well as recreational drug use. Provide details about your exercise routine, dietary preferences, and sleep patterns. These lifestyle factors can greatly impact your overall health and may contribute to underlying medical issues.
6. Fill in any recent health concerns or symptoms you have experienced. Be specific and include details such as when the symptoms started, their severity, and any factors that may worsen or alleviate them. This information helps healthcare providers identify potential underlying causes and develop appropriate treatment plans.
7. Lastly, mention any immunizations you have received and provide the dates of administration. This is important for healthcare providers to ensure that you are up to date on all recommended vaccinations and to determine if any additional immunizations are necessary.

Who needs a medical history and physical?

A medical history and physical form is typically required for individuals undergoing various healthcare evaluations or procedures. This includes:

1. New patients: When visiting a healthcare provider for the first time, they will often request a complete medical history and physical to establish a baseline of your health.
2. Preoperative evaluations: Before undergoing surgery, individuals are generally required to fill out a medical history and physical form. This ensures that the surgical team is aware of any potential risks or complications that may arise during the procedure.
3. Employment requirements: Certain jobs, especially those in healthcare or hazardous industries, may require individuals to provide a medical history and physical form to assess their ability to perform job-related tasks safely.
4. Sports participation: Athletes or individuals participating in competitive sports may be asked to fill out a medical history and physical form to determine their fitness level and identify any potential health risks.
5. Insurance applications: When applying for certain types of insurance, such as life or health insurance, the provider may request a medical history and physical examination to assess the applicant's overall health and determine appropriate coverage and premiums.

In summary, filling out a comprehensive medical history and physical form is essential for healthcare providers to gain a holistic understanding of your health status, ensure safe care, and make informed medical decisions.

For pdfFiller’s FAQs

What is medical history and physical?

Medical history and physical is a comprehensive record of a person's past medical conditions, surgeries, medications, allergies, and overall health. It also includes a physical examination conducted by a healthcare provider.

Who is required to file medical history and physical?

Individuals who are applying for certain jobs or programs that require a documented record of their medical history and physical condition are required to file this information.

How to fill out medical history and physical?

Medical history and physical forms can be filled out by providing accurate and detailed information about one's medical history, current medications, allergies, surgeries, and by undergoing a physical examination by a healthcare provider.

What is the purpose of medical history and physical?

The purpose of medical history and physical is to provide a comprehensive overview of an individual's health status, past medical conditions, and any potential risks that may impact their ability to perform certain tasks or duties.

What information must be reported on medical history and physical?

Information such as past medical conditions, surgeries, medications, allergies, family medical history, vaccinations, and the results of a physical examination must be reported on medical history and physical forms.

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