Patient medical history 2025

1. Click ‘Get Form’ to open the Patient Medical History Form in the editor.
2. Begin by entering your Name, Age, and Account Number in the designated fields at the top of the form.
3. Fill in your Occupation and describe your Type of Work, including examples such as lifting or sitting.
4. Provide your Height and Weight. Indicate whether you smoke by selecting 'Yes' or 'No'.
5. In the Past Medical History section, check 'Yes' or 'No' for conditions like High Blood Pressure or Heart Condition.
6. List any Previous medical problems or surgeries, specifying details where necessary.
7. Detail any Tests conducted while hospitalized or as an outpatient, such as CAT SCANs or MRIs.
8. Indicate any Previous orthopedic problems and provide specifics if applicable.
9. List current Medications along with their purposes.
10. Specify your Regular Exercise/activity level and Types of activities you engage in.
11. Enter information about your Doctors, including Orthopedic and Primary care providers.
12. Acknowledge awareness of your diagnosis and prognosis by selecting 'Yes' or 'No'.
13. Indicate if assistance is needed for daily tasks by checking 'Yes' or 'No'.
14. Describe how your injury or condition has affected you in the provided space.
15. Sign and date the form at the bottom to confirm accuracy of information provided.

Start filling out your Patient Medical History Form online for free today!