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PULMONARY REHABILITATION REFERRAL FORM Name:GP:DOB:GP Practice:NHS No: Address: Post Code:GP Tel No:Tel No: Medical History (List or attach a GP summary sheet of current problems and past medical
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To fill out a medical history list, follow these steps:
02
Start by entering your personal information such as your full name, date of birth, and contact details.
03
Provide details about your medical conditions and any chronic illnesses you have.
04
Mention any allergies or adverse reactions you've experienced to medications, food, or other substances.
05
Include information about any previous surgeries or hospitalizations you've had.
06
List all current medications you're taking, including prescription drugs, over-the-counter medicines, and supplements.
07
Mention any family history of diseases or conditions, especially if they may be hereditary.
08
Provide details about your lifestyle habits such as smoking, alcohol consumption, and exercise routine.
09
Finally, review the completed medical history list for accuracy and make sure to sign and date it.

Who needs medical history list or?

01
A medical history list is required for anyone seeking medical care or treatment.
02
It is especially important for new patients visiting a healthcare provider for the first time.
03
People with chronic illnesses or complex medical conditions should always carry an updated medical history list with them.
04
Additionally, individuals who are undergoing surgery, starting a new medication, or participating in a clinical trial may need to provide a detailed medical history.
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A medical history list is a comprehensive record of a person's medical background, including diagnoses, treatments, medications, surgeries, and other relevant health information.
Health care professionals, institutions, or entities that provide medical services are typically required to maintain and file a medical history list.
To fill out a medical history list, one should gather detailed information about the patient's past medical conditions, treatments received, medications taken, allergies, surgeries, and family medical history, and document it in the designated format.
The purpose of a medical history list is to provide a complete overview of a patient's past and present health status, which aids in treatment planning, continuity of care, and ensuring patient safety.
Essential information to be reported includes personal identification details, medical diagnoses, dates of treatments, medications prescribed, allergies, surgeries, and any relevant family medical history.
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