Get Patient Medical Questionnaire-04-b2013b - Advanced Orthopedic Center

This guide provides detailed instructions for users on how to accurately complete the Patient Medical Questionnaire-04-b2013b online. Following these steps ensures all necessary information is provided for optimal care at the Advanced Orthopedic Center.

Follow the steps to effectively fill out the questionnaire online.

1. Press the ‘Get Form’ button to access the Patient Medical Questionnaire-04-b2013b in the online editor.
2. Begin by entering your personal information, including your name, date of birth, and chart number as prompted on the form.
3. Provide your contact information, including the address and phone numbers indicated. Ensure accuracy for communication purposes.
4. State your chief complaint by detailing why you are visiting the doctor today. This will help the medical staff prioritize your needs.
5. Complete the medical history section thoroughly. Indicate any previous specialists you have seen for this issue and any examinations, tests, or treatments related to your chief complaint by checking the appropriate boxes.
6. Explain any incidents that may have caused your pain, such as accidents, and provide relevant dates. This information helps in understanding the context of your current condition.
7. Shade the areas on the diagram where you are experiencing pain, giving a visual representation of your concerns.
8. Provide detailed descriptions regarding your pain, including its intensity, triggers, and anything that alleviates it.
9. Fill out the review of systems by checking all relevant health issues and providing explanations where necessary.
10. List any current medications you are taking, along with dosages, and include your pharmacy name and address for reference.
11. Indicate any allergies you may have and any previous surgical procedures that are relevant to your medical history.
12. Complete the social history section by answering questions about your lifestyle, occupation, and living situation.
13. Check the US government reporting section for race, ethnicity, and language preferences, ensuring to handle this information sensitively.
14. Sign and date the form where required, confirming that the information provided is accurate and complete.
15. Once finished, you can save changes, download, print, or share the completed questionnaire as needed.

Start filling out your Patient Medical Questionnaire-04-b2013b online today for a seamless medical experience.