Personal health record template 2025

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The type of data included in a PHR is not standardized, but a typical record might include the following information: Previous ambulatory visits, hospitalizations and emergency room encounters. Known allergies. Family medical history.
Your medicines, including how much you take and how often. Illnesses and surgeries youve had and when. Procedures, such as mammograms and colonoscopies, youve had and when. Ongoing health problems, such as high blood pressure.
How do I create a Personal Health Record? You will need to request a copy of your records from each of your healthcare providers. To do so, you must complete an authorization for the release of information form for each provider. Request the form from your provider.
Here are some ideas: Use a notebook or paper filing system. Use a 3-ring binder or wire-bound notebook with dividers for each member of the family. Use your computer. Use any software program youre comfortable with, or get software specifically for personal medical records. Use a secure Internet site.
There are three types of medical records commonly used by patients and doctors: Personal health record (PHR) Electronic medical record (EMR) Electronic health record (EHR)
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To start your PHR, request copies of your current health records from all your healthcare providers. Contact your providers office or the health information management or medical records staff at any hospital or facility where you had treatment. Ask for an authorization for the release of information form.
Examples of PHI Name. Address (including subdivisions smaller than state such as street address, city, county, or zip code) Any dates (except years) that are directly related to an individual, including birthday, date of admission or discharge, date of death, or the exact age of individuals older than 89. Telephone number.

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