Get Merrimack Valley Internal Associates Medicine Medical History Form 2017-2024

In general, a medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently stopped taking.

In medicine, a social history (abbreviated "SocHx") is a portion of the medical history (and thus the admission note) addressing familial, occupational, and recreational aspects of the patient's personal life that have the potential to be clinically significant.

A record of information about a person's health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests.

Questions about past illnesses What illnesses or diseases have you had in the past? ... Since your initial diagnosis and treatment, have your illnesses returned? ... How has the illness impacted your daily life and activities? ... What medical care did you get for the illness? ... When did you first notice the disease's symptoms?

Please list any past medical history below with date of onset or diagnosis. Examples include asthma, diabetes, depression, anxiety, drug or alcohol dependency, high blood pressure, thyroid disease, autoimmune disease, chronic pain, gynecologic disorder. Have you ever had surgery?

2.3. COMPONENTS OF A HEALTH HISTORY Demographic and biological data. Reason for seeking health care. Current and past medical history. Family health history. Functional health and activities of daily living. Review of body systems.