Get Patient Info/history Sheet - Columbia Plastic Surgery

Completing the Patient Info/History Sheet is an essential step in your journey at Columbia Plastic Surgery. This guide provides clear, step-by-step instructions to help you accurately fill out the form online while ensuring your information is well-organized and easily accessible for medical professionals.

Follow the steps to effectively complete your Patient Info/History Sheet.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the date and your personal information. Fill in your full name, social security number, address details including city, state, zip code, age, and date of birth.
3. Indicate your marital status, occupation, and the gender marker that aligns with your identity.
4. Provide your contact information, including home, cell, and business phone numbers, as well as your email address.
5. List your employer's name and next of kin information. Include their relationship to you and their contact numbers.
6. Fill in the insurance information section clearly, specifying the primary and, if applicable, secondary insurance details. Ensure to have your insurance card ready for accurate information input.
7. In the medical information section, provide details about your general health, medical history, and any current treatments. Answer all questions truthfully and include explanations where necessary.
8. If applicable, answer the female-specific questions regarding menstrual health, pregnancy, and previous mammograms.
9. Indicate any allergies to medications, food, or anesthesia and provide details about existing medications you are taking.
10. Provide information on your social habits such as smoking and alcohol consumption, along with family medical history that may be relevant.
11. Include any previous surgeries and hospitalizations, detailing the nature and outcomes.
12. Complete the authorization for the disclosure of information section, ensuring you understand what you are consenting to.
13. Finally, sign and date the form to validate your entries. Be sure to review the entire sheet for accuracy before submission.

Complete your Patient Info/History Sheet online today to ensure a smooth visit at Columbia Plastic Surgery.