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Reset Medical History Statement The Standard Life Insurance Company of New York For applicants not residing in New York For Residents of: IL, NH, NJ Medical Underwriting, 900 SW Fifth Avenue Portland

How to fill out medical history statement

How to fill out a medical history statement:

1. Start by gathering all necessary information: Before filling out the medical history statement, gather any relevant medical records, previous test results, and prescriptions that you may have. This will ensure that you provide accurate and up-to-date information.
2. Begin with personal information: The medical history statement usually requires personal information such as your full name, date of birth, address, contact details, and emergency contact information. Make sure to provide accurate details to ensure proper communication.
3. Mention primary healthcare provider: Include the name and contact information of your primary healthcare provider. This allows the medical facility or healthcare professional to communicate and coordinate with your regular doctor if necessary.
4. Describe current medical conditions: Provide a comprehensive list of any ongoing medical conditions you may have, such as diabetes, asthma, heart disease, or allergies. Include details such as the date of diagnosis, current treatment plan, and medications you are taking for each condition.
5. Include surgical history: If you have undergone any surgeries in the past, include the details in your medical history statement. Mention the type of surgery, date, and the name of the surgeon or hospital where it was performed.
6. Report any current medications: List all the medications you are currently taking, including prescription drugs, over-the-counter medications, and supplements. Include the name of the medication, dosage, frequency, and the reason for taking each medication.
7. Provide details about allergies: Mention any known allergies you have, whether they are to medications, foods, environmental factors, or specific substances. Note the symptoms you typically experience when exposed to these allergens.
8. Include family medical history: Mention any significant medical conditions that run in your family, such as heart disease, cancer, diabetes, or mental health disorders. Providing this information allows healthcare professionals to assess your risk factors accurately.
9. Note your immunization history: Include a record of your immunizations, including vaccines received and their respective dates. This is important information for healthcare professionals to ensure that you are up-to-date on necessary vaccinations.
10. Review and sign the statement: Carefully review the completed medical history statement for any errors or missing information. Once satisfied, sign and date the document to indicate that the information provided is accurate and complete.

Who needs a medical history statement?

A medical history statement is typically required by healthcare providers, medical facilities, or insurers to gather comprehensive information about an individual's medical background. It is necessary for new patients, individuals undergoing medical procedures or surgeries, and those seeking health insurance coverage. Providing a detailed medical history helps healthcare professionals make informed decisions, accurately diagnose medical conditions, and provide proper care and treatment.

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What is medical history statement?

Medical history statement is a document that includes information about a person's past health conditions, treatments, and surgeries.

Who is required to file medical history statement?

Individuals who are seeking medical treatment, applying for health insurance, or participating in clinical trials 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 detailed information about their past and current health conditions, medications, allergies, surgeries, and family medical history.

What is the purpose of medical history statement?

The purpose of a medical history statement is to provide healthcare providers with important information about a person's health history, which can help them make informed decisions about treatment and care.

What information must be reported on medical history statement?

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