A Medical History Form is one of the many Medical Forms used by medical care facilities. They are used to outline a person’s medical history. The information on these forms are used to facilitate a person’s medical treatment or determine the course of his medical treatment. It is important for every physician to know about underlying medical conditions that may have triggered present symptoms, and for that purpose, Medical History Forms are used.

Every medical care facility requires new patients to fill out a Medical History Form, along with a Patient Information Form. These information are safeguarded, and kept by hospitals and clinics to be used as a reference in the patient’s visit or admission in their facility, and also for any future consultations that the patient may need.

New Patient Medical History Form

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Family Medical History Questionnaire

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Adult Personal Health Record and Medical History Form

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The Importance of Medical History Forms

  • A Medical History Form tells so much useful information about a patient that would help in administering the right medications and providing proper first aid treatments. If the patient has any allergies, they are specified in the form so that the physician can have access to all of the information he needs to treat the patient.
  • Medical History Forms are important for people with developmental disabilities who are constantly going in and out of hospitals. It is highly likely that a patient with developmental disability sees more than one doctor, so a Medical History Form would be a good way for their doctors to be aware of what their other doctors are doing to treat their medical condition.
  • Medical History Forms are good for emergencies, especially when the patient cannot communicate verbally due to the symptoms of his medical condition. A copy of a patient’s Medical History Form has to be kept in an easily accessible location so that emergency room physicians and paramedics can treat the patient in the best way possible. This is why the medical history of an individual is also included in Emergency Release Forms and Child Medical Consent Forms.
  • The past medical conditions of a patient would have to be considered when treating new symptoms and identifying new medical conditions. With the aid of Medical History Forms, a physician can identify if the symptoms are part of an already diagnosed illness or a brand new ailment.

Medical History Questionnaire Sample

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Patient Medical History Form

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Sports Medical History Form

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What to Include In a Medical History Form

  • Personal Information: This includes the person’s name, birth date, age, gender, and other similar information.
  • Known Allergies: This includes the person’s allergy to food, medications, or bee stings.
  • Insurance Information: The person’s insurance policy number and health insurance provider are almost always included on Medical Information Forms. This is necessary for the medical care facility to file a medical claim on behalf of the patient.
  • Current Medications: The names and dosage of all current medications the person is taking for current illnesses or medical conditions.
  • Past and Present Medical Conditions: This includes a list of all the serious and chronic illnesses the person has ever had. This includes illnesses like asthma, diabetes, tuberculosis, and others.
  • Medication History: This is a list of all the previous medications the person took, along with the dates when the medications were started and stopped.
  • Emergency Contacts: This includes basically all information in an Emergency Contact Form, which includes the names and contact numbers of family members and relatives, or any other emergency contact.
  • Past Surgeries and Hospitalizations: The dates and any relevant information on past surgeries and hospitalizations should be included.
  • Family Medical History: This includes information on the past medical conditions of the person’s family members, going back up to three generations.
  • Immunization History: This is a list of all the immunizations or vaccines that the person or patient has been administered with, along with the dates that those vaccinations were administered.

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