Health History Checklist

With the health history checklist, hospitals and physicians are able to obtain helpful information from their patients before their first visit. This free form is available here for easy download and can be completed in the comfort of the new patient’s home or printed. No more occurrences of patients forgetting to tell you what medications they are on, their current symptoms, or what vaccinations they have had in the past. This form helps to document all important information regarding the patient’s health history. The health history checklist helps to equip doctors with vital information that could help treat and diagnose a patient.

These downloadable forms are fully customizable. Whether your facility serves predominantly men or women, this checklist can be modified to reflect those patients. Just simply use your Microsoft Word software to revise the health history checklist so that it reflects your establishment. These modifications can also include your company’s logo and/or contact information.

How to Use the Health History Checklist Word Document

  • Download the template and open it as a Word Document
  • Revise the template to reflect your establishment. This customization includes adding your logo and contact information, removing questions that are not relevant to your practice; add other questions that may pertain to your clientele.
  • Save the document and upload the template to your website and/or have available for new patients to fill out on their first visit.

Tips for Using the Health History Checklist Word Document

  • Be sure to keep any added questions or statement free of medical jargon. This can possibly confuse the new patient and cause them to give up completing the form.
  • Use the data recorded before prescribing medications. The patient may be already taking a medication that you are considering or a medication that is in the same class as a medication that the patient is currently taking. Also, use this form to help prevent drug/drug interactions. This is important because some medications may pose a health risk when taken with other meds.
  • Review the data recorded on the health history checklist then ask the patient to elaborate on any information that confuses you or that could possibly help to reveal the root cause of certain ailments or pains.

The health history checklist can be very beneficial for a doctor and his or her patients. This checklist can reveal important information that can aid in the treatment and diagnosis of new patients.

Download: Health History Checklist

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