Get Admission Health Survey Short Form

The Admission Health Survey Short Form is a crucial document that helps establish your medical history for a smooth admission process. Completing this form accurately ensures that healthcare providers have the information they need to give you the best possible care.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to obtain the Admission Health Survey Short Form and open it in your preferred online editor.
2. Begin by filling in your height and weight in the designated fields, ensuring the information is accurate as it may impact your medical evaluation.
3. Respond to the series of yes/no questions regarding your health conditions. Circle 'Yes', 'No', or '?' (unsure) for each question provided. Be sure to add comments when prompted for clarification.
4. If applicable, list all medications you are currently taking, including non-prescription and dietary supplements. Specify the name of the drug, dosage, frequency, and the last time taken in the provided section.
5. Indicate whether you have any allergies by selecting 'Yes' or 'No'. If applicable, detail all known drug, food, and environmental allergies along with the type of reactions experienced.
6. Provide information about any previous hospitalizations or surgeries. List approximate dates and reasons, highlighting any complications that may have occurred.
7. Indicate how long you have been at altitude and specify the altitude at which you live. This information is relevant for your medical assessment.
8. Fill out your Advance Directives/Medical Treatment Decision Information by selecting the appropriate responses about your advance directives and any specific medical wishes you might have. Detail any restrictions or additional wishes in the space provided.
9. Review all sections to ensure that the information provided is complete and accurate. Once finalized, save your changes.
10. Download or print the completed form for your records, or share it as necessary with your healthcare provider.

Begin completing the Admission Health Survey Short Form online today to ensure a smooth admission process.