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General Information Patients name___ Preferred name___ Birth date___ Home Phone___ Cell Phone___ Work Phone___ Email___ Mailing Address___ City___ State___ Zip___ Employer___ Occupation___ Spouses
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01
Obtain the DPI health history form.
02
Begin by filling out your personal information such as name, date of birth, and contact information.
03
Provide details about your medical history, including any past illnesses, surgeries, or medications you are currently taking.
04
Answer any additional questions on the form regarding your current health status.
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Review the completed form for accuracy and make any necessary corrections before submitting.

Who needs dpi health history?

01
Individuals who are seeking medical treatment or services from a healthcare provider.
02
Students enrolling in a new school or educational program.
03
Employees who are required to provide health history information for insurance or occupational health purposes.
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DPI health history is a record of an individual's health information maintained by the Department of Public Instruction.
All students, staff, and faculty of educational institutions are required to file DPI health history.
DPI health history can be filled out online through the designated portal provided by the Department of Public Instruction.
The purpose of DPI health history is to ensure the safety and well-being of individuals within educational institutions by monitoring their health status.
Information such as medical conditions, medications, allergies, and vaccination records must be reported on DPI health history.
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