Get the free Functional Medicine Health History Form - Revised 11-18
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Goldwater Integrated Medicine Functional Diagnostic MedicineAUTHORIZATION FOR RELEASE OF MEDICAL RECORDS COMPREHENSIVE HEALTH HISTORY FORMS Jeffrey S. Russell, DO, FA COI, CAMP Nicole L. Hat, DC 892
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How to fill out functional medicine health history
How to fill out functional medicine health history
01
Start by gathering all necessary documents and information, such as previous medical records, current medications, and past diagnoses.
02
Begin by filling out basic personal information, including your name, date of birth, contact information, and insurance details if applicable.
03
Provide a comprehensive medical history, including any previous surgeries, hospitalizations, or significant medical events.
04
List all current medications, including dosage and frequency, as well as any supplements or alternative treatments you are currently taking.
05
Detail any allergies or adverse reactions you have experienced in the past, including medication allergies or food intolerances.
06
Describe your current symptoms and the duration and severity of each, as well as any triggers or patterns you have noticed.
07
Include information about your lifestyle and habits, such as exercise routines, dietary preferences, stress levels, and sleep patterns.
08
Provide a family medical history, including any genetic conditions, chronic diseases, or other relevant information about your close relatives.
09
Consider including a summary of your goals or concerns, and any specific questions or areas you would like the healthcare provider to focus on.
10
Double-check all information for accuracy and completeness before submitting the form.
Who needs functional medicine health history?
01
Functional medicine health history is beneficial for anyone seeking a comprehensive understanding of their health and well-being.
02
It is particularly beneficial for individuals with chronic or complex health conditions that may require a more integrative and personalized approach.
03
People who are interested in preventative care and optimizing their overall health and wellness can also benefit from functional medicine health history.
04
Functional medicine practitioners use the health history as a tool to identify underlying root causes and develop individualized treatment plans.
05
Overall, anyone who wants a holistic and personalized approach to healthcare can benefit from filling out a functional medicine health history.
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What is functional medicine health history?
Functional medicine health history is a comprehensive assessment of an individual's medical history, lifestyle, and environmental factors that impact their health. It focuses on understanding the root causes of health issues rather than merely addressing symptoms.
Who is required to file functional medicine health history?
Individuals seeking services from a functional medicine practitioner are typically required to file a functional medicine health history as part of their initial evaluation and ongoing treatment process.
How to fill out functional medicine health history?
To fill out a functional medicine health history, individuals should provide detailed information about their medical history, current health status, lifestyle habits, family health history, and any relevant environmental exposures. It's important to be thorough and honest to ensure accurate assessment and treatment.
What is the purpose of functional medicine health history?
The purpose of functional medicine health history is to gather detailed information to identify underlying health issues, develop personalized treatment plans, and monitor progress over time, aiming for holistic health restoration.
What information must be reported on functional medicine health history?
Information that must be reported includes personal medical history, current medications, allergies, family medical history, lifestyle factors (such as diet, exercise, and stress), and any previous treatments or interventions.
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