Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to start the process of obtaining the initial clinical history form and open it in your preferred editor.
2. Begin by filling in the patient information section. Enter the patient's name, race, date of birth, age, and marital status. Ensure to check the appropriate options provided.
3. Proceed to the education section. Check the highest level of education achieved by the patient and indicate their occupational history, including the employer and job title.
4. In the past medical history section, check all conditions that apply. If none, select 'None'. Make sure to review each condition thoroughly before proceeding.
5. Complete the past surgical history by documenting types of surgeries and the corresponding years they were performed.
6. Fill in non-prescription medications and prescription medications sections, detailing the medication name, dosage, and frequency.
7. Provide details regarding the patient's weight, height, and any history of blood transfusions. Additionally, document known allergies and their respective reactions.
8. If the patient is female, complete the relevant sections regarding pregnancy and menstrual history. If male, address questions related to potency.
9. Proceed to the social history section to indicate tobacco, alcohol, and drug use. Document the frequency and duration of substance use if applicable.
10. Lastly, complete the family history section, recording the medical conditions and statuses of family members. Ensure all fields are filled as accurately as possible.
11. Review all entered information for accuracy and completeness. Once satisfied, save changes, and proceed to download, print, or share the completed form as needed.

Start filling out your AZ IMA Initial Clinical History Form online today!