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Dates Revised:ADOLESCENT HEALTH HISTORY
All questions contained in this questionnaire are strictly confidential
and will become part of your medical record.
Name M(Last, First, M.I.):Marital
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How to fill out adolescent health history
How to fill out adolescent health history
01
Start by gathering necessary information about the adolescent's health and medical history.
02
Use a standardized adolescent health history form to help organize the information.
03
Begin by filling out basic demographic information such as name, age, and contact details.
04
Proceed to gather information about the adolescent's past and current medical conditions, including any chronic illnesses, allergies, or disabilities.
05
Record a comprehensive medication history, including prescription medications, over-the-counter drugs, and any supplements or vitamins being taken.
06
Document any surgeries or hospitalizations the adolescent has undergone in the past.
07
Include details about the adolescent's immunization history, ensuring all vaccinations are up to date.
08
Ask about the adolescent's family medical history, including any hereditary diseases or conditions that may impact their health.
09
Inquire about the adolescent's dietary habits, exercise routine, and any substance abuse history if applicable.
10
Be sure to maintain confidentiality and assure the adolescent that their information will be kept private and only shared with healthcare professionals involved in their care.
11
After completing the form, review it for accuracy and completeness before filing it in the adolescent's medical record.
Who needs adolescent health history?
01
Adolescent health history is needed by healthcare providers who are responsible for providing care to teenagers and young adults.
02
This includes pediatricians, family physicians, gynecologists, and specialists involved in the treatment of specific medical conditions.
03
Parents or guardians of adolescents may also find it helpful to have a complete health history for their child.
04
The information contained in the adolescent health history helps healthcare professionals make informed decisions, diagnose potential health issues, and develop appropriate treatment plans.
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What is adolescent health history?
Adolescent health history is a record of a young person's medical background, including any illnesses, medications, allergies, and past treatments.
Who is required to file adolescent health history?
Parents or guardians are typically required to file adolescent health history for minors.
How to fill out adolescent health history?
Adolescent health history can be filled out by providing accurate and detailed information about the adolescent's medical background.
What is the purpose of adolescent health history?
The purpose of adolescent health history is to provide healthcare providers with important information about the adolescent's health status and medical needs.
What information must be reported on adolescent health history?
Information such as medical conditions, medications, allergies, surgeries, and family medical history must be reported on adolescent health history.
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