House Calls Medical History Form - HCCIntelligence™ Premier Resource - 2024-House Calls Medical History Form - HCCIntelligence™ Premier Resource

House Calls Medical History Form - HCCIntelligence™ Premier Resource - 2023

Pdf Summary

The House Calls Medical History Form is a comprehensive document that collects important information about a patient's medical history. It includes sections for current and past medical issues, past surgeries, medical allergies and reactions, medications, pharmacy information, family history, ability to do activities, caregiver questions, advance directives, social history, review of systems, immunizations, durable medical equipment, recent hospitalizations, recent doctor visits, and home health/hospice agency information.<br /><br />The form asks for details such as the patient's name, birth date, and the name of the person filling out the form. It also asks for information about the main reason for the visit and the date. The form provides sections to list current and past medical issues, past surgeries, medical allergies and reactions, and medications (both prescription and over-the-counter).<br /><br />Additionally, the form asks about the patient's ability to perform various activities, such as feeding, bathing, toileting, dressing, transferring, walking, housework, meal preparation, managing money, and using the telephone. It also inquires about the caregiver's ability to provide care and take care of themselves.<br /><br />The form includes sections for advance directives, such as durable power of attorney for healthcare, living will, and do not resuscitate form. It also asks about the patient's social history, including tobacco and alcohol use, recreational drug use, sexual activity, firearms in the home, communication preference, ability to understand and read English, religion/faith, and finances.<br /><br />There is a section for reviewing various systems of the body, such as skin, head, eyes, heart, lungs, gastrointestinal, genitourinary, musculoskeletal, endocrine, neurological, and psychiatric. The form asks about any symptoms experienced in the past two weeks and provides options to indicate the frequency of these symptoms.<br /><br />Other sections of the form include immunizations, durable medical equipment, recent hospitalizations, recent doctor visits, and home health/hospice agency information.<br /><br />Completing the House Calls Medical History Form prior to the initial visit helps healthcare providers gather important information about a patient's medical history and provide the best care possible.

Keywords

House Calls Medical History Form

patient's medical history

medications

caregiver questions

advance directives

social history

review of systems

durable medical equipment

recent hospitalizations

initial visit