PRA Medical/Social History Form 2013-2025 free printable template

PRA Medical/Social History Form Directions: Please answer the following questions to the best of your knowledge. Your records are considered confidential. Your records will not be released to any

How to fill out social history medical

How to fill out PRA Medical/Social History Form

1. Begin by entering your personal information, including your full name, date of birth, and contact details at the top of the form.
2. Provide your medical history, detailing any past surgeries, chronic illnesses, or significant medical conditions.
3. List any allergies you have, including medication, food, and environmental allergies.
4. Include medications you are currently taking, specifying the name, dosage, and purpose of each.
5. Fill out your family medical history, indicating any hereditary conditions or diseases that run in your family.
6. Note any mental health conditions you have experienced, treatments you have received, or any relevant psychological history.
7. Provide information on any social factors that may affect your health, such as lifestyle choices, occupation, and substance use.
8. Review your answers for accuracy and completeness before submitting the form.

Who needs PRA Medical/Social History Form?

1. Individuals seeking healthcare services that require a comprehensive understanding of their medical and social history.
2. Patients undergoing assessments for clinical trials or specific medical procedures.
3. Healthcare providers who need detailed health information to provide appropriate care.
4. Social workers and mental health professionals evaluating patient needs.

People Also Ask about

What is an example of a patient's social history?

Social history: smoking, alcohol, recreational drugs, accommodation and living arrangements, marital status, baseline functioning, occupation, pets and hobbies. Systems review: cardiovascular system, respiratory system, gastrointestinal system, nervous system, musculoskeletal system, genitourinary system.

What is part of the social history in medical?

Social history is a broad category of the patient's medical history but may include the patients smoking or other tobacco use, alcohol and drug history and should also include other aspects of the patient's health including spiritual, mental, relationship status, occupation, hobbies, and sexual activity or pertinent

What is included in a patient's social history?

History, social: An account of a patient that puts his or her illness or behavior in context. A social history may include aspects of the patient's developmental, family, and medical history, as well as relevant information about life events, social class, race, religion, and occupation.

What are examples of social history medical?

Social History (SH): An age appropriate review of the patient's past and current activities which may include significant information about: Marital status and/or living arrangements. Current employment. Occupational history. Use of drugs, alcohol or tobacco. Level of education. Sexual history. Other relevant social factors.

How do you take social history of a patient?

Ask the patient about their family history. Ask questions about their social history and lifestyle, like what they do for a living and any smoking or alcohol habits. Wrap up by seeing if they have any questions for you, thanking them for their time and then letting them know the doctor will be with them shortly.

What is the social history of a medical form?

In medicine, a social history (abbreviated "SocHx") is a portion of the medical history (and thus the admission note) addressing familial, occupational, and recreational aspects of the patient's personal life that have the potential to be clinically significant.

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What is PRA Medical/Social History Form?

The PRA Medical/Social History Form is a document used to collect comprehensive medical and social background information from individuals, typically for the purpose of assessing eligibility for various health services, research studies, or medical treatments.

Who is required to file PRA Medical/Social History Form?

Individuals seeking certain medical services, participating in clinical trials, or entering programs that require medical evaluations may be required to file the PRA Medical/Social History Form.

How to fill out PRA Medical/Social History Form?

To fill out the PRA Medical/Social History Form, provide accurate and detailed responses to each section, which may include personal identification, medical history, current medications, allergies, and social background. Ensure to review the information for accuracy before submission.

What is the purpose of PRA Medical/Social History Form?

The purpose of the PRA Medical/Social History Form is to gather essential information that helps healthcare providers evaluate a patient's medical history and social factors that may affect their health, allowing for better individualized care and treatment planning.

What information must be reported on PRA Medical/Social History Form?

The form typically requires reporting of personal identification details, medical history, current and past illnesses, surgeries, medications, allergies, vaccination history, family health history, lifestyle factors, and social circumstances.