Get Cad Injury History Form - Katz Chiropractic

Filling out the CAD Injury History Form is an important step in ensuring comprehensive care at Katz Chiropractic. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the document editor.
2. Begin by filling in your general information. This includes your name, driver's license number, social security number, today's date, date of injury, and marital status. Be sure to enter this information accurately for proper records.
3. Provide details of your past medical history. This section requires you to list any surgeries you have undergone, including dates and any residual effects. Indicate your habits, such as tobacco or alcohol usage, and detail any fractures along with their dates.
4. Indicate your employment status both at the time of the crash and currently. Fill out the type of work you were doing, whether office-related or labor-intensive.
5. Address any serious illnesses you may have experienced, providing dates and residuals where applicable. You also need to list any prior injuries relevant to your current complaints.
6. Move on to the injury history section. Specify if the crash occurred on the job and describe your role (driver, passenger, etc.). Document the particulars about your vehicle as well.
7. Fill out the current medical history. Note any current health problems, medications you are taking, and details about the crash such as your estimated speed and conditions at the time.
8. Complete the injury history section by detailing symptoms you experienced. This includes checking off any pain or other sensations and mentioning whether you lost consciousness.
9. Describe the crash accurately, indicating whether you wore a seatbelt and if airbags deployed. Provide a diagram if needed to clarify the crash dynamics.
10. Finally, review all the information entered for accuracy. You can then save changes, download, print, or share the completed form as necessary.

Complete your CAD Injury History Form online to ensure your care at Katz Chiropractic is as effective as possible.