Pre-Registration Medical Form

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Whenever you have a medical interaction with any healthcare group, a stream of questions pours out from every new person you encounter.  Sometimes it’s easy to remember the answers because it’s a routine appointment.  Other times, anxiety fogs the memory banks, making answers difficult to recall. With my husband’s medical status, we unfortunately take unexpected trips to the  emergency department fairly often. I got tired of answering the same questions repeatedly, especially the ones about his medications and medical history. Therefore, I created the forms below. 

I assembled all the information needed by healthcare teams plus details I felt they needed to know but might not ask.  In addition, I included insurance numbers, names of physicians, and pharmacy locations.  These two sheets save us a lot of time, prevent mistakes, and keep me from having to get frustrated because “I can’t remember the name of that new medication he started two weeks ago.”

The front page of the medical profile form includes your personal profile information; demographics, insurance, physicians, primary diagnoses, surguries, pharmacy, allergies, etc.
The front page of the medical profile form includes your personal profile information; demographics, insurance, physicians, primary diagnoses, surguries, pharmacy, allergies, etc.
Page 2 of the medical profile form focuses on medications and includes both prescription and non-prescription medications that might recreate chemical interactions.
Page 2 of the medical profile form focuses on medications and includes both prescription and non-prescription medications that might recreate chemical interactions.

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