Get Uic Neurosurgery Form

This guide provides comprehensive, step-by-step instructions for users filling out the Uic Neurosurgery Form online. Our goal is to ensure that you provide accurate information regarding your medical history for the best care during your visit.

Follow the steps to accurately complete the form online.

1. Press the 'Get Form' button to access the Uic Neurosurgery Form and open it in your preferred digital editing tool.
2. Begin by filling out the general information section. Include the date, your full name (last, first, middle initial), home address, phone numbers (home and work), date of birth, and gender. Indicate your handedness by selecting left-handed, right-handed, or ambidextrous.
3. Provide details about your pediatrician or family doctor, including their name, address, and phone number. If applicable, include any referring doctors to whom you would like information sent.
4. State the main reason for your visit today. This helps the medical team understand your primary concern.
5. Indicate whether you brought any medical records, slides, or x-rays with you, selecting yes or no.
6. Describe the history of your present illness. Include information about the location, severity, and duration of symptoms, as well as any factors that improve or worsen the symptoms.
7. Fill out your medical history, confirming if you had a term birth and the method of delivery. List any medical conditions and note if they are currently under treatment.
8. Detail any previous hospitalizations or surgeries, including dates and the types of surgeries performed.
9. Review the developmental history section. Circle all applicable skills your child has acquired.
10. Indicate whether the patient is currently undergoing physical therapy, occupational therapy, or speech therapy. Select yes or no for each.
11. List current medications taken, along with dosage, route, start date, and purpose.
12. Document known drug allergies if any exist, providing the name of the medication and the reaction experienced.
13. Fill in family history of illnesses that are prevalent in your family, ensuring to capture relevant details.
14. Complete the social history section. Circle the highest level of education attained and specify who the patient lives with.
15. For the review of systems section, check all symptoms that describe your condition across various medical categories.
16. At the end, sign the form as either a patient, parent, or guardian. Ensure that all information is accurate and complete.
17. Save the changes to your document. You may download, print, or share the completed form as needed.

Complete your Uic Neurosurgery Form online for a smoother appointment experience.