Personal Medical History Template
| Allergy | Presently |
|---|---|
| Convulsions | Presently |
| Dizziness | Presently |
| Fainting | Presently |
| Fatigue | Presently |
| Headache | Presently |
| Nervousness | Presently |
| Neuralgia | Presently |
| Numbness | Presently |
| Pain in arms/legs/hands | Presently |
| Backache | Presently |
|---|---|
| Foot trouble | Presently |
| Hernia | Presently |
| Pain between shoulders | Presently |
| Painful tail bone | Presently |
| Stiff neck | Presently |
| Spinal curvature | Presently |
| Swollen joints | Presently |
| Tremors | Presently |
| Twitching | Presently |
| Weakness | Presently |
| High blood pressure | Presently |
|---|---|
| Low blood pressure | Presently |
| Pain over heart | Presently |
| Poor circulation | Presently |
| Previous heart trouble | Presently |
| Stroke | Presently |
| Swelling of ankles | Presently |
| Varicose veins | Presently |
| Chest pain | Presently |
| Chronic cough | Presently |
| Difficulty breathing | Presently |
I hereby authorize the company to examine and treat my condition as deemed appropriate through the use of Chiropractic Care, and give authority for these procedures to be performed. It is understood and agreed the amount paid to the Doctor for Xrays is for examination only and the Xray negatives will remain the property of this office, being on file where they may be seen at any time while a patient of the office. The patient also agrees that he/she is responsible for all bills incurred at this office. The Doctor will not be held responsible for any pre-existing medically diagnosed conditions nor for any medical diagnosis.
Collecting medical data is difficult. If you are working for a massage therapist company and looking for collecting data such as chiropractic information, you can use this Medical Record PDF template. Chiropractic care is a form of alternative medicine that focuses on the relationship between the body's structure, primarily of the spine, and function. With this Medical History Record PDF template, you can pick your patients who are suitable for this treatment.
This Medical History Record PDF template has seven different categories that allow you to collect patients' data such as personal information, family history, and habits like; smoking, coffee and alcohol, general symptoms, muscles and joints, cardiovascular symptoms, and the patient operations and procedures of the past years. Also, to help keep patient data safer, you can opt in to one of our HIPAA-friendly plans.
Dental Health Record Template
The Dental Health Record Template is easy for patients to fill out and designed to get the doctor the most important information. Patients can fill out their information on a computer or tablet using our Dental Health Record Template.
Simple Medical History Template
Once you have collected these medical data, you can record them as a pdf by using this medical history PDF template. In addition, you don't need to be worried about the safety of data.
Child Medical History Template
This child medical history PDF template makes checking patients vitals and recording that important data easy. Add your own branding, adjust fields for your specific needs and then simply print out your PDF for the patient's file.
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Professional Medical History Template
Medical History Record PDF template is here to help you in order to know the patient's case and previous condition. You can collect data about the patient and medical background with this Medical History Record PDF sample.
Medical Case Report
Provide the best health care to the people by using evidence-based care study by using this Medical Case Report template. This template contains all the information required in conducting research and report.
These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.