Medical History Form - acadderm.com 2025

1. Click ‘Get Form’ to open the Medical History Form in the editor.
2. Begin by entering your name, date of visit, date of birth, and age in the designated fields. Select your gender by checking either 'M' or 'F'.
3. In the 'Reason for dermatology visit' section, provide a brief description of your visit purpose.
4. For medical conditions, indicate any past ('P') or current ('C') problems by checking the appropriate boxes. Use 'Other' for conditions not listed.
5. List any drug allergies and reactions in the specified area. If none, simply write 'None'.
6. Document current medications and past surgeries with dates in their respective sections. Again, if there are none, write 'None'.
7. Fill out family history by indicating any relevant conditions among blood relatives. Use 'Unknown/Adopted' if applicable.
8. Complete social history regarding tobacco and alcohol use, as well as other health-related questions.
9. Finally, provide the name of your primary care provider if applicable before saving or submitting your form.

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