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Transgender Medical History Form and Consents V3.docx

Transgender Medical History Form and Consents V3.docx 2025

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4.9 out of 5

38 votes

The document is a comprehensive Transgender Medical History Form designed to collect detailed personal, medical, surgical, and family history from transgender patients. It includes sections on patient demographics, medical history, surgical history, allergies, medications, sexual history, occupational and leisure activities, family health history, gynecological and obstetrical history (if applicable), urological history (if applicable), previous infertility testing and treatment, as well as patient responsibilities and consents regarding financial policies and communication methods. The form aims to gather essential information for providing appropriate medical care and fertility treatment.

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Versions	Form popularity	Fillable & printable
2021	4.7 Satisfied (27 Votes)
2018	4.9 Satisfied (38 Votes)

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How do I bill a transgender medical claim?

Briceo advised physicians to foster a nonjudgmental and respectful environment, using inclusive language to reassure and welcome transgender patients. For example, physicians should not assume the patients gender identity, and instead should ask the patients preferred name and pronouns.

What is the informed consent model of transgender care?

Previously, your medical record had only one place for your sex and gender. Now, you can have both your Birth Sex and your Gender Identity in your medical record. If you wish to change your Birth Sex information after talking with your health care team, this is your right in the VA system.

What is the medical term for transgender people?

Practitioners and non-physician practitioners should append modifier -KX to the gender-specific CPT code at the service line level. Institutional Providers should add the condition code 45 to the appropriate claim field to indicate a gender-specific service.

How to medically document transgender?

Ideally, the patients chosen name, pronouns, and gender will be displayed first so that relevant staff know how to address the patient. Their legal name should be available for those who deal with insurance and billing issues.