Past Medical History
|
|
Preferred pharmacy
|
|
Medical History
|
|
Past Medical History
• • •
|
Past Medical History Freewrite
|
Childhood illnesses
• • •
|
Comments
|
Childhood Immunizations
• • •
|
Comments
|
|
|
PCP
|
PCP Contact Information
|
PSH
|
|
Past Surgical History
• • •
|
Past Surgical History
|
Health Maintenance
|
|
Health Maintenance
|
|
Health maintenance free text
|
|
Colonoscopy
|
|
Mammogram
|
|
Pap smear
|
|
last physical exam
|
|
Eye Exam
|
|
FAMILY HISTORY
|
|
Family History free text
|
|
Father's MH
• • •
|
Comments
|
Mother's MH
• • •
|
Comments
|
Sibling(s)' MH
• • •
|
Comments
|
Grandparent's MH
• • •
|
Comments
|
Children(s)' MH
• • •
|
Comments
|
Social History
|
|
Social History
|
|
Social History free text
|
|
Marital Status
• • •
|
|
Living Arrangements
• • •
|
Potential Environmental Pathogen
|
Sexual Hx
|
Comments
|
Occupation
|
|
Caffeine
|
Comments
|
Tobacco use:
|
Quit tobacco use
|
Alcohol
|
Comments
|
Other substances
|
|
Patient's diet
|
|
GYN History
|
|
GYN History free text
|
|
OB History
|
|
OB History
|
|
Immunizations:
|
|
Immunizations free text
|
|