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PRIVATE HEALTH INFORMATION KEEP CONFIDENTIALKansas State High School Activities AssociationPREPARTICIPATION PHYSICAL EVALUATION INSTRUCTIONS STUDENTS/PARENTS 1.Complete the History Form (pages 1 &
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How to fill out complete the history form

01
Start by entering your personal information such as name, date of birth, and contact details.
02
Provide details about your medical history including any past illnesses, surgeries, or medications taken.
03
Fill out information regarding your family medical history, such as any inherited conditions or diseases.
04
Include details about your lifestyle habits such as diet, exercise routine, and any substance use.
05
Be sure to accurately complete all sections of the history form and update it regularly as needed.

Who needs complete the history form?

01
Patients visiting a healthcare provider for the first time.
02
Patients undergoing a medical procedure or treatment.
03
Individuals participating in a research study or clinical trial.
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Patients seeking a second opinion or transferring care to a new provider.
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Complete the history form is a document that requires individuals to provide detailed information about their personal, medical, and travel history.
Anyone who is a new patient at a healthcare facility or is seeking medical treatment is required to file a complete the history form.
To fill out the complete the history form, individuals need to provide accurate and detailed information about their health conditions, past medical treatments, surgeries, medications, allergies, and family medical history.
The purpose of the complete the history form is to help healthcare providers assess a patient's health status, identify potential risks or complications, and provide appropriate medical care.
Information such as personal details, medical history, medications, allergies, surgeries, hospitalizations, family medical history, and emergency contacts must be reported on the complete the history form.
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