Get Mercy General Health Partners Initial Patient History Form - Lakeshore ...

Completing the Mercy General Health Partners Initial Patient History Form is an essential step in ensuring you receive appropriate medical care. This guide provides clear, step-by-step instructions to help you fill out the form online effectively and accurately.

Follow the steps to complete your patient history form online.

1. Press the ‘Get Form’ button to access the initial patient history form and open it in your preferred editing tool.
2. Input today's date in the designated field on the form. This helps to maintain an accurate record of your visit.
3. Enter your name, date of birth, sex, and marital status. Ensure that the information is correct and legible.
4. Provide your address and telephone numbers for both home and work. Include your employer and occupation for additional context.
5. Indicate who is completing the form. This can be you or someone assisting you. Also, provide your church affiliation if applicable.
6. Detail your current or main medical problems in the provided field to inform your healthcare provider of your primary concerns.
7. Respond to questions regarding your use of glasses, hearing aids, and any relevant sensory disabilities with 'Yes' or 'No'.
8. Specify the reason for your visit or any particular issues you would like to address during your appointment.
9. List any previous illnesses, medical issues, and hospitalizations as prompted in the relevant sections.
10. Document any current medications, including over-the-counter drugs, along with their doses and frequency.
11. Indicate any known allergies and adverse reactions, along with details of the reactions suffered.
12. Provide information about your immunizations by filling in the year for each applicable vaccine.
13. Detail your family history, noting any health issues experienced by blood relatives.
14. Fill in your social history, including use of tobacco, alcohol, and any other relevant lifestyle factors.
15. Review the sections on the review of systems, checking significant and circling current problems.
16. Complete any remaining sections specific to men or women, including reproductive health details.
17. Answer sensitive questions regarding personal safety as truthfully as possible to allow for appropriate support.
18. If applicable, express any additional concerns or notes you wish to share with your provider.
19. Finally, sign and date the form where indicated to confirm that the information provided is accurate.
20. Once all sections are completed, you can save your changes, download the document, print it, or share it as needed.

Start filling out your initial patient history form online today to ensure a smooth and effective healthcare experience.