Personal Medical History Template
| Allergy | Presently |
|---|---|
| Convulsions | Presently |
| Dizziness | Presently |
| Fainting | Presently |
| Fatigue | Presently |
| Headache | Presently |
| Nervousness | Presently |
| Neuralgia | Presently |
| Numbness | Presently |
| Pain in arms/legs/hands | Presently |
| Backache | Presently |
|---|---|
| Foot trouble | Presently |
| Hernia | Presently |
| Pain between shoulders | Presently |
| Painful tail bone | Presently |
| Stiff neck | Presently |
| Spinal curvature | Presently |
| Swollen joints | Presently |
| Tremors | Presently |
| Twitching | Presently |
| Weakness | Presently |
| High blood pressure | Presently |
|---|---|
| Low blood pressure | Presently |
| Pain over heart | Presently |
| Poor circulation | Presently |
| Previous heart trouble | Presently |
| Stroke | Presently |
| Swelling of ankles | Presently |
| Varicose veins | Presently |
| Chest pain | Presently |
| Chronic cough | Presently |
| Difficulty breathing | Presently |
I hereby authorize the company to examine and treat my condition as deemed appropriate through the use of Chiropractic Care, and give authority for these procedures to be performed. It is understood and agreed the amount paid to the Doctor for Xrays is for examination only and the Xray negatives will remain the property of this office, being on file where they may be seen at any time while a patient of the office. The patient also agrees that he/she is responsible for all bills incurred at this office. The Doctor will not be held responsible for any pre-existing medically diagnosed conditions nor for any medical diagnosis.
Collecting medical data is difficult. If you are working for a massage therapist company and looking for collecting data such as chiropractic information, you can use this Medical Record PDF template. Chiropractic care is a form of alternative medicine that focuses on the relationship between the body's structure, primarily of the spine, and function. With this Medical History Record PDF template, you can pick your patients who are suitable for this treatment.
This Medical History Record PDF template has seven different categories that allow you to collect patients' data such as personal information, family history, and habits like; smoking, coffee and alcohol, general symptoms, muscles and joints, cardiovascular symptoms, and the patient operations and procedures of the past years. Also, to help keep patient data safer, you can opt in to one of our HIPAA-friendly plans.
COVID-19 Vaccine Administration Record
Keep track of patient vaccination records online. More secure with GDPR, CCPA, and optional HIPAA compliance features. Download or print as PDFs. Free, easy-to-customize template.
First Aid Incident Report Template
Incidents must be reported and recorded to be sure that correct actions and treatment are made which should trigger management awareness and an investigation. The First-Aid Incident Report template contains injured person's personal details and contact details, the details and visible symptoms of injury, the Glasgow Coma Scale which is a neurological scale that expects to give a dependable and target method for chronicle the condition of an individual's awareness and brief information of treatment. Also, it contains the profile of the first-aider and signature of the person who prepares the report.
Simple Medical History Template
Once you have collected these medical data, you can record them as a pdf by using this medical history PDF template. In addition, you don't need to be worried about the safety of data.
Dietary Requirements Template
Collect important information about food restrictions and allergies. Save submissions as PDFs. Easy to customize, download, print, and share with kitchen staff.
Child Medical History Template
This child medical history PDF template makes checking patients vitals and recording that important data easy. Add your own branding, adjust fields for your specific needs and then simply print out your PDF for the patient's file.
Short Medical History
Medical History Record PDF template is mostly used in order to provide significant information about the health history, care requirements, and risk factors of the patient to doctors. It is for collecting data from the patients.
These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.