Get Coastal Spine And Pain Center Initial Office Visit Patient Information Sheet 2016-2025

This guide provides comprehensive instructions for users filling out the Coastal Spine And Pain Center Initial Office Visit Patient Information Sheet online. By following these steps, you can ensure that all necessary information is accurately recorded, facilitating a smooth consultation process.

Follow the steps to complete the patient information sheet online.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by filling out your personal information at the top of the form. This includes your name, age, sex, who referred you, and today’s date.
3. In the 'Current Problems' section, list your chief complaint and any accompanying symptoms. You have space for up to four issues.
4. In 'History of Present Illness,' provide the date of your initial symptoms. If applicable, describe your situation; if you are filling this out due to a work or personal injury, skip this section.
5. Answer the questions under 'On the Job/Personal Injury History,' marking yes or no as appropriate. If yes, provide details regarding the accident and where you sought initial care.
6. Indicate how you would rate your pain at its worst and on average using the numerical scale provided.
7. Check all applicable pain descriptions in the 'Pain Description' section.
8. In 'Prior Treatment,' indicate whether you have seen another physician for the same issue and detail any previous treatments.
9. List any types of therapy you have previously undergone, such as physical therapy or acupuncture.
10. Describe how your condition limits your daily activities in the 'Activity Limitations' section.
11. Next, indicate any previous diagnostic studies you have undergone and specify the approximate month and year.
12. In 'Past Medical History,' list any relevant medical issues and provide details about any surgeries you've had.
13. In the 'Medications' section, accurately fill in all medications you are currently taking, separating pain medications from others.
14. Indicate any allergies you have, including food or medication allergies.
15. Answer the personal questions regarding mood swings, tobacco use, alcohol consumption, and substance abuse as prompted.
16. Provide information about your family history of similar conditions, if applicable.
17. Complete the 'Personal/Social History' section by answering questions about your tobacco and alcohol use, employment status, and any disability benefits.
18. Check any relevant issues in the 'Review of Systems' section.
19. Once you have filled out all required sections, review your answers for accuracy.
20. Finally, save the completed form, and choose to download, print, or share your document as needed.

Complete the Coastal Spine And Pain Center Initial Office Visit Patient Information Sheet online today for a streamlined experience.