Get Health History Form - Duquesne University - Duq

Filling out the Health History Form at Duquesne University is a crucial step in ensuring your health information is accurately recorded for medical services. This guide will take you through each section of the form, providing clear instructions to assist you in completing it online.

Follow the steps to complete the Health History Form effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin with the Personal Data section. Fill in your full name, address, sex, birthdate, and marital status. Ensure that all information is accurate and complete.
3. Proceed to the Parents/Guardians section. Enter the details of your parents or guardians, including their names, addresses, and telephone numbers.
4. In the University Data section, specify your major, course of study, and whether you are an undergraduate or graduate student. Indicate your enrollment term and if you are a resident, commuter, or transfer student.
5. Provide your Health Care Provider Information. List your primary care physician's name, phone number, and address if applicable.
6. In the Current Health Information section, input your height and weight, and indicate if you have any allergies. If yes, specify the allergens.
7. List any medications you take in the Medications section, indicating the drug, dosage, and reason for taking it.
8. Check boxes regarding any limitations or disabilities you may have and specify details where necessary.
9. Complete the Health History section by indicating any past medical issues you have experienced. Provide additional information if needed.
10. State whether you have ever been hospitalized or had serious injuries and provide relevant details.
11. Address any mental health concerns you may have by answering the related questions and providing details when applicable.
12. If you identify as female or male, complete the corresponding Women’s Health or Men’s Health sections by checking relevant conditions.
13. Fill in your Family History, detailing the health of living family members and marking any applicable medical conditions.
14. Finally, provide your signature and date indicating the accuracy of the information. Save your changes to keep your work.

Complete your documents online to ensure your health information is processed swiftly.