Get New Patient Assessment Form - Pattee Md

Completing the new patient assessment form is an essential step for users seeking orthopedic care at Pattee MD. This guide provides a detailed walkthrough of each section of the form, ensuring a seamless online experience for users.

Follow the steps to successfully complete the form online.

1. To access the form, click the ‘Get Form’ button to retrieve the document and open it for completion.
2. Begin filling out your personal information. Provide your name, today's date, height, age, weight, handedness, birthdate, occupation, and email address.
3. Clearly indicate the reason for your visit by stating the condition or problem that is prompting your visit to the office. Additionally, include the name of the person who referred you.
4. Indicate when your symptoms began and whether this is a new condition or an issue you’ve experienced in the past. If applicable, provide a brief description of how the symptoms developed or how the injury occurred.
5. Assess any symptoms experienced when moving your shoulder, arm, or elbow. Mark any relevant symptoms such as crunching, catching, grinding, or locking.
6. Indicate whether your condition interferes with sleep and assess your current pain level by marking the appropriate line from 0 (no pain) to 10 (severe pain).
7. Answer the questions regarding your shoulder/elbow stability and note any activities that worsen the pain. Provide a list of medications currently being used for this condition.
8. Respond to inquiries about past neck issues, and if applicable, describe the nature of those issues.
9. Mark any areas of numbness or tingling experienced and describe any difficulties encountered during various physical activities.
10. Review your medical history, noting any evaluations by other doctors, physical therapies, tests, or surgeries related to your condition.
11. Complete the illnesses section by indicating your history with conditions such as heart disease, diabetes, or any other relevant issues.
12. Detail your current medications including dose, amount, and frequency. Also, report any allergies or medication intolerances you may have.
13. Provide a comprehensive review of your systems, including general symptoms and any issues related to vision, hearing, respiratory health, and more.
14. Fill out your social history, including marital status, alcohol and tobacco use, and any exposure to harmful substances.
15. Provide your family history with details on age, diseases or conditions affecting family members. This includes parents, siblings, and other relatives.
16. Conclude by signing the form as the patient, or have a parent or guardian sign if applicable. Include the physician's signature and date where indicated.
17. After completing all sections, save any changes made, download the completed form, print it for your records, or share it as needed.

Complete your new patient assessment form online to ensure a thorough evaluation of your condition.