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Y to contact you? Home phone Cell phone Work phone Email Best time to call: Phone #: Email Address: Primary Care Physician: Referring Physician: Address: Address: Phone Number: Phone Number: Present Medical History: Oncology Service Have you been diagnosed with: soft tissue mass/tumor bone lesion/tumor Has the tumor been biopsied? Yes No Location of tumor/mass/lesion: Have you had prior: Chemotherapy Yes No Radiation Yes No Surgery Y.

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Any patient interview should start with the HPI (history of present illness, which makes up the “7 dimensions”: Chronology, Location, Quantity, Quality, Aggravating and Alleviating factors (what makes the problem Better or Worse), Setting, and Associated Manifestations.

In general, a medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently stopped taking.

Any patient interview should start with the HPI (history of present illness, which makes up the “7 dimensions”: Chronology, Location, Quantity, Quality, Aggravating and Alleviating factors (what makes the problem Better or Worse), Setting, and Associated Manifestations.

Here are some important areas an effective medical history form should cover: Patient contact information. Age and gender. History of surgeries and treatments. Previous tests and scans. Dates and timeline of symptoms. Family medical history. Past diseases and illnesses. Known allergies.

History of Present Illness Chief complaint (CC) History of present illness (HPI) Review of systems (ROS) Past, family and/or social history (PFSH)

Patient history should always feel more like a conversation rather than an interrogation. It's important to establish trust, respect and honesty so that they feel relaxed and comfortable. You can do this through little gestures like making small talk and asking what their preferred name is.

A record of information about a person's health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise.

A comprehensive patient interview includes inquiring about the patient's medical, medication, social, personal, and family history, as well as a thorough review of systems and possibly a physical examination.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232