medical history form
Hospital admissions can sometimes be stressful. Repetitive questions are
asked by doctors, nurses, etc. The questions asked are necessary to ensure
that an adequate assessment is done and that quality care is given.
There are times when the family has to spend extended time at the hospital
during the admission process because the patient is unable to provide the
information.
Our medical history form will answer most questions asked during a typical
admission, a time that can be very stressful.
Have answers to these and other questions available on one form:
- Past medical History
- Insurance company name and policy number
- Advance directive information
- Medications
Once you receive your medical history form fill in the information required
(pencil is suggested, as information may change over time) and keep your
medical history form in a secure place until needed. During admission or office
visit simply present your completed medical history form to the doctor or
nurse or have them to make a copy, but be sure to keep the original for your
records. .

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