Medical History
|
|
Past Medical History
• • •
|
Past Medical History Freewrite
|
Past Surgical History
• • •
|
Past surgery Freewrite
|
Childhood illnesses
• • •
|
Comments
|
PCP
|
PCP Contact Information
|
|
|
Family History
|
|
Family medical history
• • •
|
Comments
|
Social History
|
|
Marital Status
• • •
|
Comments
|
|
|
Occupation
|
Comments
|
Caffeine
|
Comments
|
Alcohol
|
|
Smoking history
|
|
Patient's diet
|
Comments
|
Exercise
• • •
|
|
|
Comments
|