Medical History Form

Will has been asked to write more detailed histories of the patients he sees in the clinic of the family practice doctor he is job shadowing. Because his stroke affected his language skills, he continues to struggle expressing himself with verbal and written language. A form has been created to assist him with medical history taking which could probably use some help.

A SAMPLE HISTORY FORM

1- Patient’s Name_____________
2- Patient’s Age______________
3- Patient’s Blood Pressure______
4- Patient’s Weight__________Height_____
5- Patient’s Temperature_______________
6- Patient’s Signs and symptoms__________
7-Allergies__________________________
8- Medications_______________________
9- Past Pertinent History ________________
10- Events Leading to the problem _________
11- Problem_________________________
12- Diagnosis_________________________
13- Prescriptions and/or procedures_________

Any insights or resources on taking medical histories would be greatly appreciated.