Get Patient Venous History

Filling out the Patient Venous History form is an important step in assessing your venous health. This guide will help you navigate each section of the form, ensuring that you provide complete and accurate information for optimal care.

Follow the steps to successfully complete the Patient Venous History form.

1. Press the ‘Get Form’ button to access the Patient Venous History form and open it in your preferred digital editor. This will allow you to fill it out efficiently and accurately.
2. Begin by entering your personal information. This includes your full name and date of birth at the top of the form.
3. Indicate whether you have received any previous treatment for varicose or spider veins. Circle 'YES' or 'NO' and provide details such as dates and types of treatments if applicable.
4. Answer the questions regarding your medical history, including ulcerations, chronic swelling, blood clots, and family history of related conditions.
5. Provide information about any hormone therapy or birth control pills that you are currently using or have used in the past.
6. Report on any pregnancies you have had, specifically the number of children and if varicose veins increased after pregnancy.
7. Indicate whether you have worn prescription stockings or hose.
8. State your current employment status and describe your job, including how long you sit or stand during work hours.
9. Describe how your condition affects your daily activities, including the frequency and timing of any discomfort or pain.
10. Indicate if you have used pain medication for your varicose or spider veins and list any medications.
11. State whether you elevate your legs to relieve symptoms and describe the effectiveness of this method.
12. Mention if you are following any weight loss or management routine.
13. Indicate your exercise habits and the intensity of your workouts.
14. Finally, report any severe leg injuries or major surgeries you have had, and check all relevant symptoms pertaining to both legs.
15. After filling out all sections of the form, you can save your changes, download a copy for your records, print it out, or share it as needed.

Complete your Patient Venous History form online to ensure a thorough assessment of your venous health.