Family medical history template 2025

1. Click ‘Get Form’ to open the family medical history template in the editor.
2. Begin by entering your Current Physician's Name and Phone Number. This information is crucial for any future medical consultations.
3. Next, fill in the Current Pharmacy's Name and Phone Number to ensure easy access to your medications.
4. In the CURRENT/PAST MEDICATIONS section, list each medication along with its dose, frequency, start and end dates, prescribing physician, and purpose. This comprehensive detail helps healthcare providers understand your medication history.
5. For SURGICAL PROCEDURES, document the date of each procedure, the type of surgery performed, the physician who conducted it, the hospital where it took place, and any additional notes that may be relevant.
6. In the MAJOR ILLNESSES section, record any significant illnesses you have experienced along with their start and end dates, treating physician details, and treatment notes.
7. Finally, complete the VACCINATIONS section by listing all vaccines received along with their dates. Include common vaccines like Tetanus and Influenza as well as any others relevant to your health history.

Start using our platform today to easily manage your family medical history for free!