Get Tx Austin Regional Clinic Established New Orthopedic Problem Questionnaire 2015

This guide provides a comprehensive, step-by-step approach to filling out the TX Austin Regional Clinic Established New Orthopedic Problem Questionnaire online. By following these instructions, you will be able to complete the form accurately and efficiently, ensuring that your healthcare history is documented correctly.

Follow the steps to successfully complete the questionnaire.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin with providing your personal details. Enter your first name, last name, today's date, and date of birth in the designated fields.
3. Indicate your age, preferred language, and race/ethnicity to ensure proper personalization of care.
4. Provide the name of your primary care doctor or provider as well as the referring physician, if applicable. Check the option if your primary doctor is the same as your referring physician.
5. Answer whether the orthopedic problem was caused by an injury. If yes, specify if it is work-related and provide details about your employer and occupation.
6. Indicate any allergies to medications by selecting yes or no. If applicable, provide details about the medication and your reaction.
7. In the 'History of Chief Complaint' section, detail the body part you are consulting for, the nature of your complaint, how and when it began, and its severity.
8. Describe what worsens and improves your symptoms, any remedies you have attempted, and previous similar issues or injuries in the same area.
9. List your current height, weight, and preferred pharmacy details including its address and phone number.
10. Enumerate all medications you are currently taking in the specified area, indicating each one clearly.
11. Complete the review of systems section by answering yes or no to each condition listed.
12. Fill out your medical history thoroughly, marking yes or no for each diagnosis listed.
13. Detail any surgical history, providing information on past surgeries and dates if applicable.
14. Finally, review all the information you have entered for accuracy, make any necessary changes, and save your changes. You can also choose to download, print, or share the completed questionnaire.

Complete your TX Austin Regional Clinic Established New Orthopedic Problem Questionnaire online today for a thorough and efficient healthcare experience.