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Physical Form Name: ___ Gender: ___ Date of birth: ___ Date: ___Part 1: Health questionnaire (to be completed by the patient) Instructions: Please read the following questions and answer them with

How to fill out history and physical form

How to fill out history and physical form

1. Start with the patient's personal information: name, date of birth, and contact details.
2. Record the reason for the visit or the chief complaint.
3. Fill out the medical history section, including past medical conditions, surgeries, and hospitalizations.
4. Include medication history: current prescriptions, over-the-counter medications, and supplements.
5. Document any allergies, noting the specific allergens and reactions.
6. Complete the family history section with relevant health conditions of immediate family members.
7. Note the patient's social history, including lifestyle factors such as smoking, alcohol use, and exercise habits.
8. Perform a physical examination and document findings in the appropriate section.
9. Sign and date the form, confirming that all information is accurate.

Who needs history and physical form?

1. Patients undergoing medical examinations or seeking treatment.
2. Healthcare providers who need a comprehensive understanding of a patient's health.
3. Insurance companies that require this information for coverage purposes.
4. Emergency services to understand a patient's health history in urgent situations.

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What is history and physical form?

The history and physical form is a document used in healthcare to record a patient's medical history and physical examination findings. It serves as a systematic approach to gathering comprehensive health information.

Who is required to file history and physical form?

Healthcare providers, including physicians and healthcare facilities, are required to file a history and physical form for each patient before certain medical procedures or admissions.

How to fill out history and physical form?

To fill out the history and physical form, clinicians must gather information regarding the patient's medical history, current medications, allergies, and conduct a physical examination. This information should be documented clearly and accurately in the designated sections of the form.

What is the purpose of history and physical form?

The purpose of the history and physical form is to provide a comprehensive overview of the patient's health status, establish a baseline for future medical care, and facilitate informed decision-making for treatment.

What information must be reported on history and physical form?

The information that must be reported includes the patient’s demographics, medical history, family history, social history, current medications, allergies, vital signs, and findings from the physical examination.