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How to use or fill out UPDATE HISTORY FORM2 - Foothill Family Clinic Draper
- Click ‘Get Form’ to open it in the editor.
- Begin by entering your name and birthdate at the top of the form. This information is essential for identifying your medical records.
- In the 'Prescription Medications' section, list all medications you are currently taking, including over-the-counter drugs and supplements. Fill in the medication name, strength, frequency, and reason for each medication.
- Indicate if a refill is needed for each medication by checking 'Y' or 'N'.
- Next, document any medication allergies you have along with their reactions in the designated fields.
- Complete the social history section by answering questions about tobacco, alcohol, and caffeine use. Be sure to specify types and amounts where applicable.
- Provide details on any recent surgeries or hospitalizations under past medical history. Include dates and locations.
- Fill out family history by marking any relevant conditions that have affected family members since your last physical.
- Finally, review systems by circling any health issues that apply to you from the provided list.
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See more UPDATE HISTORY FORM2 - Foothill Family Clinic Draper versions
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4.8 Satisfied (89 Votes) |
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