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HOWARD UNIVERSITY STUDENT HEALTH CENTER WASHINGTON, DC 20059 Fax (202) 8067416 Phone (202) 8067540 The following health history is confidential and does not affect your admission status. This information

How to fill out medical entrance hx form

1. Start by gathering all necessary information: Before filling out the medical entrance hx form, make sure you have collected all the relevant details pertaining to your medical history. This may include previous diagnoses, medications you are currently taking, surgeries you have undergone, allergies or adverse reactions to medications, and any chronic illnesses you have.
2. Complete personal information section: Begin by filling out the personal information section of the form. This typically includes your full name, date of birth, gender, contact information (address, phone number, email), and any identification numbers or social security numbers required.
3. Provide emergency contact information: In this section, fill out the details of a reliable person who can be contacted in case of an emergency. Include their name, relationship to you, and their contact number.
4. Mention current healthcare provider: Indicate the name and contact information of your current primary healthcare provider, including their address and phone number. This is crucial as it allows the medical institution to coordinate care effectively and obtain your medical records if required.
5. Document your medical history: Carefully provide an accurate account of your medical history. Start by documenting any existing medical conditions, such as diabetes, asthma, hypertension, or mental health disorders. Be sure to mention the dates of diagnoses and any relevant medications or treatments you have undergone.
6. List current medications: Include a comprehensive list of all the medications you are presently taking, including prescription drugs, over-the-counter medications, supplements, and herbal remedies. Specify the name of the medication, dosage, frequency, and the reason for taking it.
7. Note any allergies or adverse reactions: Clearly state any known allergies or adverse reactions you have experienced in the past, whether it be to medications, food, environmental factors, or latex. This information is vital for ensuring your safety during any medical procedures or treatments.
8. Provide surgical history: If you have undergone any surgeries in the past, include the type of surgery, the date it was performed, the name of the surgeon, and the outcome or purpose of the procedure.
9. Mention family medical history: The medical entrance hx form may also ask for details regarding your family's medical history. Provide information about any significant illnesses or hereditary conditions that run in your immediate family, such as diabetes, cancer, heart disease, or any other condition that may be relevant.
10. Sign and date: Finally, read through the completed form to ensure accuracy and completeness. Sign and date the form as required, indicating your consent and understanding of the information provided.

Who needs medical entrance hx form?

1. Students applying for admission to medical schools or programs often need to fill out a medical entrance hx form. This allows the institutions to evaluate the student's medical history, ensuring that they meet the required health standards for acceptance.
2. Individuals seeking employment in healthcare settings, such as hospitals, clinics, or research facilities, may be required to complete a medical entrance hx form. This helps employers assess the applicant's health status, evaluate any potential occupational health risks, and ensure their ability to perform the duties required of the position.
3. Patients visiting certain medical specialists or undergoing specific medical procedures for the first time may need to fill out a medical entrance hx form. This allows the healthcare provider to gather comprehensive information about the patient's medical history, ensuring accurate diagnoses and appropriate treatment plans.
4. Individuals participating in clinical trials or medical research studies may also be required to complete a medical entrance hx form. This helps researchers assess the participant's eligibility and suitability for the study, ensuring their safety and providing valuable data for scientific investigations.

Remember, the specific need for a medical entrance hx form may vary depending on the institution, organization, or specific circumstances, so it is essential to follow any instructions provided and provide accurate information.

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What is medical entrance hx form?

The medical entrance hx form is a document used to collect information about an individual's medical history and any pre-existing conditions.

Who is required to file medical entrance hx form?

Students applying for medical entrance exams or programs are usually required to file the medical entrance hx form.

How to fill out medical entrance hx form?

The medical entrance hx form can be filled out by providing accurate information about one's medical history, including any past illnesses, surgeries, or medications.

What is the purpose of medical entrance hx form?

The purpose of the medical entrance hx form is to ensure that students are physically fit to pursue a career in the medical field and to determine if any accommodations are necessary.

What information must be reported on medical entrance hx form?

Information such as past medical conditions, surgeries, hospitalizations, medications, allergies, and family history of illnesses must be reported on the medical entrance hx form.