Get Tx Austin Regional Clinic Established New Orthopedic Problem Questionnaire 2021-2025

Filling out the TX Austin Regional Clinic Established New Orthopedic Problem Questionnaire online is an important step in addressing your orthopedic health concerns. This guide will provide you with clear instructions to navigate through each section of the form with ease.

Follow the steps to complete the questionnaire effectively.

1. Click ‘Get Form’ button to obtain the form and open it for filling out online.
2. Provide your personal details: Enter your first name and last name. Make sure to accurately input today’s date, your date of birth, age, preferred language, and race/ethnicity.
3. Identify your healthcare providers: Provide the name of your primary care doctor and the referring physician, if applicable. If the referring physician is the same as your primary doctor, you can select that option.
4. Inquire about your injury: State whether the orthopedic problem was caused by an injury. If so, document the date of injury and indicate if it is work-related along with your employer's name.
5. Provide your medication allergies: Indicate if you have allergies to any medications and describe any reactions you have experienced.
6. Document other known allergies: Confirm if you have any additional allergies, including to metals, and provide details if applicable.
7. Complete the history of your chief complaint: Answer questions regarding the body part of concern, the nature of your complaint, the onset and severity of the issue, and identify triggers for worsening or improving symptoms.
8. Fill in your medical history: Indicate any past medical conditions, existing medication regimen, and any surgeries you have undergone in relation to your current issue.
9. Detail your family history and social history: Include relevant information about your family's medical background and lifestyle habits, including tobacco and alcohol use.
10. Finalize your submission: Review all entered information for accuracy, then save changes, and if desired, download or print a copy of the completed questionnaire.

Take the next step in your healthcare journey by completing the TX Austin Regional Clinic Established New Orthopedic Problem Questionnaire online.