Momentum Physical formrapy Past Medical History free printable template

Momentum Physical Therapy PAST MEDICAL HISTORY FORM Patient Name Date Yes Are you presently working Date of injury / onset / No Date of next physician s visit Have you ever had these symptoms before Check which apply to your symptoms Work related injury Recurrence of previous injury Motor vehicle accident Injury related to lifting Cause unknown Athletic / recreational injury Have you had a related surgery Other Do you have or have you had any of the following Diabetes Chest Pain / Angina High...

How to fill out past medical history

How to fill out Momentum Physical Therapy Past Medical History

1. Start with your personal information: name, date of birth, and contact details.
2. Provide information about your primary care physician and any referring physician.
3. List all past medical conditions, including surgeries and chronic illnesses.
4. Include any medications you are currently taking or have taken in the past.
5. Note any allergies you have, including reactions to medications or substances.
6. Mention your family medical history, focusing on hereditary conditions.
7. Describe any previous physical therapy experiences and their outcomes.
8. Ensure all information is accurate and up-to-date.

Who needs Momentum Physical Therapy Past Medical History?

1. Individuals seeking physical therapy for rehabilitation or recovery.
2. Patients with a history of chronic illnesses or injuries requiring assessment.
3. Anyone who has undergone surgery and needs physical therapy as part of their recovery.
4. Individuals requiring documentation of medical history for new healthcare providers.

Instructions and Help about past medical history

Mr. Jones the next part of the interview is past medical history and what I want to talk with you about here is things that have happened in the past with you diseases that you can remember since you were a child the first question that I want to talk with you about is as an adult when you think back to your childhood are there any illnesses that you've had diagnosed as an adult nah not really all right when you think back on your childhood are there or did you have the normal childhood the routine childhood illnesses or were you vaccinated against them either one on the first site I got you know the normal like chickenpox etc, but no vaccinations all right any medications that you take every day I take a few okays what do you take um there is to'm blanking on the name but if it's its for allergies, and you take it every day clarity you take care Clinton every day yes okay and does that work for your allergies does that help you okay any other medicines that you take every day um I have to take an okay and what is that for it's for hair loss okay anything else no okay have you ever had surgery no no have you ever had any major injuries that took you to the hospital or made you seek medical care um broke my finger once but other than that which finger the index on your right index okay and how did you break that basketball how long ago was that oh seven years ago okay have you had any problems with it since no okay ever been in the hospital other than when you were born no no okay are you up-to-date on all your immunizations mm-hmm okay are you allergic to any medications um Pennington to and what happens when you take um I get freezing shake a lot it's no fun okay all right you mentioned that you take clarity for allergies are those seasonal allergies yeah okay do you know what they are I don't know are you allergic to anything else no okay

People Also Ask about

What is H&P in medical chart?

History and Physical Examination (H&P) Examples | Medicine Clerkship (Inpatient)

How do you write a past medical history?

This article explains how. Step 1: Include the important details of your current problem. Timing - When did your problem start? Step 2: Share your past medical history. List all your past medical problems and surgeries. Step 3: Include your social history. Step 4: Write out your questions and expectations.

What is the purpose of a history and physical H&P?

The History and Physical Exam, often called the "H&P" is the starting point of the patient's "story" as to why they sought medical attention or are now receiving medical attention.

What is included in a patient's history and physical?

In general, a medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently stopped taking.

What is an H&P form?

The H&P: History and Physical is the most formal and complete assessment of the patient and the problem. H&P is shorthand for the formal document that physicians produce through the interview with the patient, the physical exam, and the summary of the testing either obtained or pending.

What is included in a history and physical H&P note?

This includes reviewing any pre-existing conditions, past hospitalizations and surgeries, allergies, medications being taken, and family medical history.

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What is Momentum Physical Therapy Past Medical History?

Momentum Physical Therapy Past Medical History is a comprehensive record that documents a patient's previous medical conditions, surgeries, treatments, and health issues that may impact their current physical therapy treatment.

Who is required to file Momentum Physical Therapy Past Medical History?

Patients seeking treatment at Momentum Physical Therapy are required to file their Past Medical History to ensure that therapists have the necessary information to provide safe and effective care.

How to fill out Momentum Physical Therapy Past Medical History?

To fill out the Momentum Physical Therapy Past Medical History, patients should provide accurate details regarding their personal health history, including any chronic conditions, previous injuries, surgeries, medications, and allergies.

What is the purpose of Momentum Physical Therapy Past Medical History?

The purpose of the Momentum Physical Therapy Past Medical History is to inform therapists of a patient's medical background, which assists in customizing treatment plans and avoiding potential risks or complications.

What information must be reported on Momentum Physical Therapy Past Medical History?

The information that must be reported includes prior diagnoses, past surgeries, current medications, known allergies, family health history, and any other relevant medical conditions.