Get Medical Intake Form - Edward Hospital - Edward

Filling out the Medical Intake Form for Edward Hospital is an important step in receiving quality healthcare. This guide will provide you with detailed instructions to help you complete the online form accurately and efficiently, ensuring that your healthcare professionals have the necessary information to assist you.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Medical Intake Form and open it in your preferred editor.
2. Begin by entering your name and occupation in the designated fields. This information is crucial for identifying your records.
3. Indicate whether you have a pacemaker and if you smoke by selecting ‘Yes’ or ‘No’ for each question. If you smoke, specify the number of packs per day.
4. If you are a woman, answer the question regarding pregnancy status and, if applicable, provide your due date.
5. List any allergies you may have, particularly to medications or latex, by checking ‘Yes’ or ‘No’ and providing specific details if needed.
6. Review the list of symptoms provided and check all that apply to your current health condition.
7. Indicate any past diagnoses from the given conditions by checking the relevant boxes. If needed, provide additional information as required.
8. Respond to the questions regarding feelings of depression and interest in receiving help by checking ‘Yes’ or ‘No’.
9. Provide a detailed list of all current medications, including prescription and non-prescription drugs, along with the reasons for taking each.
10. Document any surgeries or hospitalizations you have had, including the dates. Be thorough to ensure complete medical history.
11. Utilize the body chart to indicate areas of pain using the specified symbols, ensuring accurate depiction of your symptoms.
12. Rate your current and past pain levels on a scale from 0 to 10. Include any notes on your symptoms and their status.
13. Lastly, fill in the dates of your last and next doctor visits, as well as your expectations for attending therapy.
14. If there is any additional information you would like the therapist to know, state it clearly in the provided section.
15. Sign and date the form, either electronically or by hand, to confirm the accuracy of the information provided.
16. Once you have completed the Medical Intake Form, save your changes, and proceed to download, print, or share the completed document as needed.

Complete your Medical Intake Form online today to ensure prompt and effective care.