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Adult Patient History Form - The Family Doctor - thefamilydoctor

Adult Patient History Form - The Family Doctor - thefamilydoctor 2025

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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 such as 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 your medical records.
In the section regarding current illnesses, provide details about any ongoing treatments or medical issues, including the names of physicians treating you.
Indicate any allergies by checking 'Yes' or 'No' and list specific medications that cause adverse reactions if applicable.
List all medications you are currently taking, including prescriptions and over-the-counter drugs, in the designated fields.
Complete the medical history section by marking any past illnesses or surgeries you've experienced, along with relevant years.
Fill out family history by checking any hereditary conditions present in your family members.
Provide information on tobacco, alcohol, and drug use as well as exercise habits to give a comprehensive view of your lifestyle.
Finally, sign and date the form at the bottom before submitting it for review.

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