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MEDICAL HISTORY FORM Patient Name: DOB: Date: Chief Complaint/Reason for visit: Medication List: Please list all medications, over the counter drugs and supplements you are currently taking. Name:

How to fill out medical history form

How to fill out medical history form

1. To fill out a medical history form, follow these steps:
2. Start by providing your personal details such as your full name, date of birth, and contact information.
3. Next, detail your medical history by listing any previous illnesses, surgeries, or hospitalizations you have had in the past.
4. Include information about any ongoing medical conditions you are currently being treated for.
5. Mention any allergies or adverse reactions you have experienced to medications, foods, or other substances.
6. Provide a complete list of medications you are currently taking, including prescription drugs, over-the-counter medications, and supplements.
7. Mention any family history of medical conditions, such as heart disease, diabetes, or cancer.
8. Don't forget to include information about any lifestyle factors that may be relevant to your health, such as smoking or alcohol consumption.
9. Finally, review the form for accuracy and completeness before submitting it to the medical professional or institution.

Who needs medical history form?

1. Anyone seeking medical care or treatment needs to fill out a medical history form.
2. This includes new patients visiting a doctor's office, individuals seeking hospital admission, and those undergoing surgical procedures.
3. Additionally, individuals participating in clinical trials or research studies may also be required to complete a medical history form.

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