The FREE gray multi-table Health Care Consumer Questionnaire is a comprehensive medical history form designed to be filled out by the health care consumer prior to a visit with a health care provider. This MedicalTemplate is appropriate for a new patient evaluation or any visit to a health care provider.
The Health Care Consumer Questionnaire is a detailed 8-page snapshot of an individual’s current and past medical problems.
Information included in the colorful table format Health Care Consumer Questionnaire
* Allergies
* Medications
* Surgeries
* Past Medical History
* Family Medical History
* Review of systems
* Social History
* Religious and cultural beliefs
* Travel history
* Occupational history
* Carcinogen exposure history
* Behavioral risk factors
| Updated: | 2008-02-21 |
| License: | Free |
| Publisher: | e-MedTools |
| Size: | n/a |
| Require: | |
| System: | Win95, Win98, WinME, WinNT3x, WinNT4x, WinXP, Win2000, Win2003, Unix, Linux, MacOSX |
| Language: | English |