Comprehensive Health History Template

31 state provincial and territorial affairs and 42 psychologists in independent practice have summarized the record keeping laws of each state and compiled state specific electronic health record ehr templates that are required because of state specific laws.

Comprehensive health history template. Used by doctors to review the health pattern of the patient over time a medical history form is not a replacement for a doctor s medical files. The importance of a medical history form. The students have granted permission to have these h ps posted on the website as examples. There is no known family history of hypertension diabetes or cancer.

Electronic health record templates. Generally a well developed slightly obese elderly black woman sitting up in bed breathing with slight difficulty. Comprehensive adult history and physical sample summative h p by m2 student chief complaint. Patient is a 48 year old well nourished hispanic male with a 2 month.

As mentioned above a medical history form is one of the most useful medical forms available to doctors. Comprehensive patient medical history form. History of present illness. History and physical examination h p examples.

The most comprehensive health evaluation available in this country. Temperature 100 2 pulse 96 regular with occasional extra beat respiration 24 blood pressure 180 100 lying down 2. You will note that it may be. It is long because it is comprehensive.

If you are uncomfortable with any question do not answer it. Good past illnesses. I got lightheadedness and felt too weak to walk source and setting. The following questionnaire will assist your physician in formulating a comprehensive medical history that we will keep current over the years as you return for annual re evaluations.

Has not taken any medications past medical history general state of health. History of present illness hpi throbbing for the past two hours can feel pulse in temples 4 on a scale of 1 10 started while in the student center checking her mailbox. Please fill in all. The form template covers personal health history health habits and personal safety family health history female and male specific history and other symptoms.

Your answers on this form will help your clinician understand your medical concerns and conditions. If you are a current patient there is a shorter update form you ca n use. Have new patients complete this health history questionnaire form prior to their first appointment. The links below are to actual h ps written by unc students during their inpatient clerkship rotations.