Get the free Personal Health Record - Carmella Rose Health Foundation
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Personal Health Record www.carmellarose.org216.658.6025Date: Personal Information Name: Date of Birth: Address: Home Phone: Cell Phone: Work Phone: Email: Medical Conditions 1. Date diagnosed: Doctor
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How to fill out personal health record
How to fill out personal health record
01
Gather all your medical records and test results, if available.
02
Start by entering your personal information such as name, date of birth, and contact details.
03
Include information about your primary care physician and other healthcare providers you frequently visit.
04
List all your known medical conditions, including chronic illnesses, allergies, and previous surgeries.
05
Provide a detailed medication list, including the name, dosage, and frequency of each medication.
06
Record any known family medical history, such as genetic disorders or hereditary conditions.
07
Include information about your immunizations and vaccinations.
08
Document any previous hospitalizations or emergency room visits.
09
Keep track of any ongoing treatments or therapies you are currently undergoing.
10
Regularly update your personal health record whenever there are changes or new medical information becomes available.
Who needs personal health record?
01
Anyone who wants to have a comprehensive overview of their medical history and health information.
02
Individuals with chronic illnesses who require frequent medical treatments and interventions.
03
Patients who see multiple healthcare providers and need to consolidate their medical information.
04
People who travel frequently and may require immediate access to their health records in case of emergency.
05
Caregivers who need to manage and track the health information of their loved ones.
06
Individuals who want to actively engage in their healthcare and make informed decisions.
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