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SCHWARTZ PEDIATRICS PATIENT NAME: DATE OF BIRTH: ETHNICITY:CHECK MOST Appropriate AFRICAN Americano Caucasian Other Asian HISPANIC SOCIAL HISTORY:CIRCLE YES OR NO TO THE FOLLOWING QUESTIONSCHILD BREASTFED?YESNOSMOKERS
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How to fill out past medical history

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Begin by gathering all relevant medical information and records, including any previous diagnoses, treatments, surgeries, or hospitalizations.
02
Create a timeline of significant medical events, starting from the earliest to the most recent ones.
03
Note down any chronic conditions or ongoing medical issues that you have or had in the past, including allergies or sensitivities to medications.
04
Include information about any medications you are currently taking or have taken in the past, including dosage and duration.
05
Provide details about any family history of medical conditions or illnesses, as this can be important for identifying potential genetic predispositions.
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Include any relevant mental health history or treatments you have received, such as therapy or psychiatric medications.
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Consult with your healthcare provider if you are unsure about any specific details or need assistance in filling out your past medical history.
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Who needs past medical history?

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Anyone seeking medical care or treatment would benefit from having a past medical history. This includes individuals visiting a new healthcare provider for the first time, those undergoing surgery or other medical procedures, and anyone with ongoing medical conditions who require regular monitoring and management. Past medical history is important for healthcare professionals to better understand a patient's overall health, identify potential risk factors, and make informed decisions regarding their treatment.
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Past medical history refers to a patient's previous medical conditions, surgeries, treatments, and any significant medical events that have occurred in the past.
Patients are required to provide their past medical history to their healthcare providers or when applying for medical insurance.
To fill out past medical history, patients can provide information about their previous medical conditions, surgeries, treatments, and any significant medical events on a medical history form or during a medical appointment.
The purpose of past medical history is to help healthcare providers understand a patient's health background, identify any potential risk factors, and make informed decisions about their care and treatment.
Information that must be reported on past medical history includes previous medical conditions, surgeries, treatments, allergies, medications, family history of diseases, and any significant medical events.
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