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Adult Patient History Form - The Family Doctor - thefamilydoctor

Adult Patient History Form - The Family Doctor - thefamilydoctor 2026

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The document is an Adult Patient History Form designed to collect comprehensive medical information from patients. It includes sections for personal details, current and past medical conditions, allergies, medications, surgical history, family medical history, lifestyle habits (tobacco and alcohol use), and socioeconomic status. The form aims to help healthcare providers understand the patient's health background for better treatment.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and date of birth at the top of the form. This information is essential for identifying your medical records.
In the section regarding current illnesses, provide details about any ongoing treatments from other physicians, including their names.
Next, indicate any allergies you have by checking 'Yes' or 'No' and listing specific medications if applicable.
List all medications you currently take, including prescriptions and over-the-counter drugs, in the designated area.
Complete the medical history section by marking any past illnesses or surgeries you've experienced.
Fill out your family history by checking relevant medical problems and noting relationships to you.
Finally, provide information on tobacco, alcohol, and drug use as well as socioeconomic details before signing and dating the form.

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