Get Adult Physical Health Questionnaire - Torrance Memorial Physician ... - Tmphysiciannetwork

Filling out the Adult Physical Health Questionnaire is a crucial step in ensuring your health information is accurately captured. This guide will walk you through the process of completing this form online, making it straightforward and manageable for all users.

Follow the steps to fill out the questionnaire effectively.

1. Press the ‘Get Form’ button to access the form and open it in your desired PDF editor.
2. Begin by entering your name, today's date, and date of birth in the provided fields.
3. Address any changes in medications by selecting ‘Yes’ or ‘No’ and listing the names and dosages of all medications you are currently taking, including over-the-counter and supplements.
4. Indicate if you have any allergies by checking ‘Yes’ or ‘No’, and specify the allergens and reactions.
5. Fill out your past medical and surgical history, listing surgeries with the year and your specialists with their respective specialties.
6. Document your immediate family history, including any significant medical conditions and ages of family members.
7. Complete the social history section by noting if you need an interpreter, preferred language, employment status, and satisfaction with work.
8. Choose your marital status, describe your relationships with family, and specify ongoing care or advanced directives as applicable.
9. Indicate your smoking, alcohol, and drug use habits by selecting appropriate options.
10. Detail your lifestyle choices, including any specific diet and exercise routine, and provide preventive care information, such as dates of your last physical exam and any screenings.
11. For the depression screening, circle the numbers that best reflect your experiences over the last two weeks.
12. Finish the alcohol screening test by marking your responses, and calculate your total score.
13. Review all entered information for accuracy, make any necessary corrections, and finally, save your changes, download a copy, or print the completed form.

Complete your Adult Physical Health Questionnaire online to maintain your health and well-being.