Write Signatory Patient Medical History For Free

I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested (e.g., medical-history form you filled out; physician and nurses' notes; test results; consultations with specialists; referrals).]

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?

Anyone documenting in the medical record should be credentialed and/or have the authority and right to document as defined by facility policy. Individuals must be trained and competent in the fundamental documentation practices of the facility and legal documentation standards.

The following is a list of items you should not include in the medical entry: Financial or health insurance information, Subjective opinions, Speculations, Blame of others or self-doubt, Legal information such as narratives provided to your professional liability carrier or correspondence with your defense attorney,

The patient, including minors, can write an "Addendum" to be placed in their medical file. The original information will not be removed, but the new information, signed and dated by the patient, will be placed in the file.

Get the Basic Information: This includes past medical history, medications, allergies, medications, and information about chronic conditions like diabetes and any complications. Additional details like the treating physician, last encounter and how well the condition is controlled should be included.

Here are some important areas an effective medical history form should cover: Patient contact information. Age and gender. History of surgeries and treatments. Previous tests and scans. Dates and timeline of symptoms. Family medical history. Past diseases and illnesses. Known allergies.