Get Unmc-p Orthopaedic Surgery New Patient Information Form

Completing the UNMC-P Orthopaedic Surgery New Patient Information Form online is an essential step in receiving care. This guide provides a clear and supportive approach to help users accurately fill out each section of the form.

Follow the steps to successfully complete the patient information form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Fill in the date and time of your appointment at the top of the form. Ensure to include the current date and specific time.
3. Enter your full name in the provided space. This should match your identification documents.
4. Input your height and weight in the respective fields, followed by your age and body mass index (BMI). This information assists healthcare professionals in understanding your overall health.
5. Specify the reason for your visit. Be as detailed as possible to help the medical team address your concerns effectively.
6. Indicate the date of injury or onset of your complaints, if applicable. This is crucial for diagnosing the issue.
7. Complete the section regarding whether the injury is work-related. If yes, include the name of your employer and your current work status.
8. List the name and phone number of your primary care physician as well as any referring physician, if applicable.
9. Review your medical history by marking 'Yes' or 'No' for each medical problem listed. Detail all 'Yes' answers for clarity.
10. Document any surgeries and their dates, as well as any hospitalizations unrelated to surgeries.
11. List all current medications you take, including prescriptions and over-the-counter drugs.
12. Note any allergies or adverse reactions to medications in the corresponding field.
13. Provide information on your social history, including tobacco, alcohol, and recreational drug use, if applicable.
14. Describe your occupation and educational background.
15. Share information on your recreational activities and family medical history.
16. Complete the system review by checking any applicable conditions and providing explanations where necessary.
17. Sign and date the form at the bottom to certify that the information is accurate.
18. Ensure that a physician signs the initial review of the form, and make note of any periodic updates as needed.
19. After completing the form, save your changes, download a copy, print it for your records, or share it if required.

Complete your form online today to ensure a smooth and efficient healthcare experience.