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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 1999 | 4.9 Satisfied (385 Votes) |
The form collects detailed information about the patient's medical history, including major illnesses, previous treatments, and current medications.
It includes a section for family health history, allowing patients to indicate any hereditary conditions that may affect their treatment.
Patients are asked to describe their present symptoms and indicate the duration of these symptoms, which aids in diagnosis.
The form assesses social history, including lifestyle choices such as smoking, alcohol consumption, and exercise habits that can impact health.
A comprehensive review of systems is included to identify any additional health issues across various bodily systems.
Patients evaluate their ability to perform daily activities, providing insight into how their condition affects their quality of life.
The form captures referral details, helping healthcare providers understand the patient's journey and previous care received.
