Get the free Medical History Statement - ABD, 8738w_abd.pdf. CalPERS Disability Retirement Electi...

Reset MEDICAL HISTORY STATEMENT Standard Insurance Company Medical Underwriting 900 SW Fifth Ave Portland OR 97204-1282 FOR ABD POOL FOR RESIDENTS OF CALIFORNIA. DIRECTIONS: This form must be completed

How to fill out medical history statement

How to fill out a medical history statement:

1. Begin by gathering all relevant medical documents, such as previous medical records, test results, and prescriptions.
2. Provide accurate personal information, including your full name, date of birth, address, and contact information.
3. Detail any chronic illnesses or conditions you have been diagnosed with, including allergies, asthma, diabetes, or heart disease.
4. Provide a comprehensive list of all medications you are currently taking, including the dosage, frequency, and the reason for taking each medication.
5. Mention any previous surgeries or hospitalizations you have undergone, including the dates and reasons for these procedures.
6. Include information about any known allergies you have, such as food allergies, drug allergies, or latex allergies.
7. Mention any mental health conditions you have been diagnosed with, such as depression, anxiety, or bipolar disorder.
8. Provide details about any substance abuse issues or addiction problems you have had in the past or are currently struggling with.
9. Include information about any genetic disorders or family history of illnesses that may be relevant to your medical history.
10. Sign and date the medical history statement once you have reviewed it for accuracy and completeness.

Who needs a medical history statement:

1. Individuals who are seeking medical treatment or care from a new healthcare provider or facility.
2. Patients who are participating in clinical trials or research studies.
3. Individuals who are applying for life insurance or disability insurance.
4. Students enrolling in certain educational programs or specialized schools.
5. Athletes or individuals participating in sports activities that require a medical clearance.
6. Individuals applying for certain jobs in healthcare or safety-sensitive industries.
7. Patients undergoing surgery or invasive medical procedures.

Remember, it is important to provide honest and accurate information on your medical history statement to ensure that you receive appropriate medical care and follow-up treatments.

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What is medical history statement?

A medical history statement is a document that details an individual's past and current medical conditions, treatments, and other relevant health information.

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 should provide accurate and thorough information about their medical history, including any previous diagnoses, treatments, and surgeries.

What is the purpose of medical history statement?

The purpose of a medical history statement is to provide relevant health information to employers or insurers in order to assess an individual's risk and eligibility for certain benefits or coverage.

What information must be reported on medical history statement?

Information that must be reported on a medical history statement may include past medical conditions, medications, surgeries, hospitalizations, family medical history, and lifestyle habits.