Get Patient Health History Form (english) - Cadence Physician Group

Filling out the Patient Health History Form is an essential step in ensuring your healthcare team has the necessary information to provide you with the best care possible. This guide will help you navigate the form, ensuring you complete each section accurately and efficiently.

Follow the steps to successfully complete the Patient Health History Form.

1. Click ‘Get Form’ button to access the Patient Health History Form and open it in the online editor.
2. Input your personal information including your name, today's date, date of birth, and preferred language in the designated fields.
3. Indicate your pharmacy preference by providing the name, town, and street of your local pharmacy.
4. Review the Patient’s Medical History section and circle 'yes' or 'no' for each condition listed. Be sure to consider any past medical issues or diagnoses.
5. Proceed to the Patient’s Surgical History section and similarly circle 'yes' or 'no' to any prior surgeries you have undergone.
6. Complete the Patient’s Social History section, noting tobacco and alcohol use as well as any internal drug use. Specify your comments and provide details as applicable.
7. Document your family's medical history, including the status and health conditions of your relatives, using the provided fields.
8. Fill out the Patient’s Family History section by placing an ‘X’ in the appropriate boxes to indicate which family members are alive or deceased.
9. Provide information regarding health maintenance dates, including your last screenings and vaccinations in the specified section.
10. If you see other physicians, list their names and reasons for consultation as prompted in the form.
11. Once all sections are complete, review your information for accuracy. You can then save changes, download, print, or share the form as needed.

Ensure your health information is up-to-date by completing documents online today.