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How to use or fill out Medical History Form - Planned Parenthood - plannedparenthood with our platform

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information at the top, including your name, chart number, today's date, and date of birth.
In the 'Medical History' section, answer all questions accurately. Indicate any preferred names and gender pronouns.
Proceed to the 'Medication History' section. List any medications you take regularly and note if you've taken any today.
Complete the 'Allergies' section by specifying any allergies you have, including reactions.
Fill out the 'Surgical/Hospitalization History' and 'Family History' sections as applicable.
Continue through the form, addressing social history, vaccinations, tobacco and alcohol use, sexual history, STI history, HIV testing, relationship history, GYN history, PAP history, birth control history, and OB history.
Review all entries for accuracy before saving or submitting your completed form.

Start using our platform today to easily fill out your Medical History Form for free!

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Does Planned Parenthood keep medical records?

We are required by law to keep the information and records we have about your health, health status, and health services you receive at our office private and to provide you with this notice about our privacy practices.

Will my doctor know I went to Planned Parenthood?

We may disclose health information about you to doctors, nurses, technicians, health students, volunteers or other personnel who are involved in taking care of you.

How to get paperwork from Planned Parenthood?

You usually will be able to receive your health information free of charge. However, in rare cases we may charge a fee in order to cover the costs of responding to your request. If you have any additional questions, please docHub out to Medical Records at medicalrecords@planned.org or 619-881-4530.

What documents do you need for Planned Parenthood?

Be sure to bring these items to your appointment: Photo identification. Insurance card, if you have coverage. Payment for services is required if you do not have insurance or do not plan to use insurance. Accepted forms of payment include:

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