Get Heart & Health Institute Medical And Surgical History Form_dsa

Filling out the Heart & Health Institute Medical And Surgical History Form_DSA online can help streamline your medical documentation. This guide provides step-by-step instructions to ensure you complete the form accurately and efficiently, prioritizing your health history.

Follow the steps to complete your medical and surgical history form.

1. Click ‘Get Form’ button to obtain the form and open it in a digital format for completion.
2. Begin by entering your personal details. Fill in your name and date of birth at the top of the form.
3. In the medical history section, list any diseases or illnesses you have been diagnosed with, including the year of diagnosis.
4. Provide surgical history by detailing any procedures you have undergone, along with the month and year it took place.
5. In the hospitalizations section, indicate the reasons for any hospital stays with the corresponding month and year.
6. Detail any known allergies by providing the name of the allergen and your reaction to it.
7. Review and answer the social history questions regarding alcohol and tobacco use, providing details as applicable.
8. Record your family history by listing any significant illnesses encountered by family members, noting if they are alive or deceased.
9. Complete the section on your last medical exams and vaccinations by entering the dates in MM/YY format.
10. For users identifying as women, answer the questions regarding menstruation, pregnancies, and menopause status.
11. List any medications you are currently taking, including the name, dose, and frequency.
12. Fill out the pharmacy information, including the name and location, and provide a phone number for contact.
13. Once you've completed the form, ensure all information is accurate. You can then save changes, download, print, or share the completed form as needed.

Complete your form online today to ensure your health records are up-to-date.