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Get Chief Complaint Form
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How to fill out the Chief Complaint Form online
Filling out the Chief Complaint Form online is a straightforward process that allows healthcare providers to accurately capture your health concerns. By following the steps outlined in this guide, you will be able to effectively complete the form with all necessary information.
Follow the steps to complete the Chief Complaint Form accurately.
- Press the ‘Get Form’ button to access the Chief Complaint Form and open it in your browser.
- Provide your patient information in the designated fields. This includes your last name, first name, middle initial, Social Security Number, and date of birth.
- In the chief complaint section, describe your current condition. Reference up to three specific conditions that bring you to the office today.
- Indicate where you experience pain by clicking on the corresponding options for right and left side body markers.
- Respond to the question regarding how long you have had each condition by filling in the duration since you first noticed it.
- Provide information about potential causes or incidents that might have led to your current conditions.
- If you have received prior treatment for these conditions, detail the treatment and its effectiveness.
- Describe what makes each of your conditions better or worse, and provide sensory descriptions of your pain.
- Indicate whether your condition is constant or intermittent.
- If applicable, note if your pain travels and specify the locations involved.
- Rate your current pain level on a scale from 0 to 10, with 0 indicating no pain and 10 representing the worst pain imaginable.
- Rate the pain you experienced when it first started using the same scale.
- Explain any variations in your condition that may worsen or improve at different times of the day, month, or during specific seasons.
- After completing the form, you can save your changes, download a copy, print the form, or share it as needed.
Complete the Chief Complaint Form online today to ensure your healthcare provider receives the necessary information to assist you.
If you are seeing your primary care doctor the chief complaint might be, “annual physical exam, ” or “shortness of breath” or “chest pain” or even “I just don't feel good.” In orthopedics, most of the time when the surgeon lists the chief complaint they describe which joint you have pain in.
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