History and physical template 2025

1. Click ‘Get Form’ to open the history and physical template in the editor.
2. Begin by entering the date at the top of the form. Next, fill in patient information including name, age, date of birth, race, sex, marital status, number of children, previous family physician, and referring physician.
3. In the 'Reason for Visit' section, provide a brief description of the patient's visit purpose. Then check all applicable conditions under 'Past Medical History'.
4. List any past surgical history by specifying the type of surgery and year in the designated fields.
5. Document prescription and non-prescription medications by filling in medication names along with their respective doses per day.
6. Indicate any drug allergies and their reactions. Complete sections on social history regarding tobacco, alcohol, drug use, exercise habits, and caffeine consumption.
7. Fill out educational background and occupational history. Include family medical history for immediate relatives.
8. For female patients, answer questions related to pregnancy and menstrual history; for males, address impotency concerns. Lastly, document immunizations and screenings as needed.

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