General Medical History Form

This questionnaire contains questions on the hydration habits. This will help you understand hydration habits and imporve your hydration habits to lead a healthy lifestyle.

The NIH stroke scale, also known as the National Institutes of Health Stroke Scale (NIHSS), is a standardized assessment tool used to measure the severity of a stroke. It is used to assess the presence and severity of neurological deficits resulting from a stroke and to monitor the patient's progress over time. 

The Glasgow Coma Scale (GCS) is a neurological scale that is used to assess the conscious state of a person. It is used to measure the level of consciousness in a person following a traumatic brain injury. 

Goldberg's mania scale is a self-report tool developed by Dr. Ivan Goldberg to help healthcare professionals assess for symptoms of mania in individuals. The scale includes questions about mood, behavior, cognition, and energy levels.

The Pain Assessment in Advanced Dementia (PAINAD) scale assesses pain in individuals with advanced dementia.

A patient satisfaction questionnaire is a survey that measures how satisfied a patient is with the care they have received from a healthcare provider.

The Behavioral Pain Scale (BPS) is a tool used to assess the level of pain in individuals who are unable to communicate their pain level verbally. It is based on observing pain-related behaviors, such as grimacing, moaning, and body movements.

A COPD assessment test is a diagnostic procedure used to evaluate the severity of Chronic Obstructive Pulmonary Disease (COPD) and to determine whether an individual is a good candidate for certain treatments.

This questionnaire is a screening tool for physicians to assist their clinical evaluation of insomnia.

The Symptom Checklist Assessment Scale is a tool used to evaluate mental health symptoms. It is a self-report questionnaire consisting of a list of symptoms that may indicate a mental health disorder.

The Barthel index of daily living is a method of assessing and communicating to other health professionals the degree of disability in a particular individual.

The aim of the questionnaire is to understand what people think about medications. This helps establish the likelihood of a person being compliant with medications.

Separation anxiety disorder is a condition where your child finds it difficult to cope with brief periods of separation from parents or other caregivers. 

A trauma bond is a strong emotional connection between two people who have gone through a traumatic experience together. The bond is often formed because the two people have depended on each other for survival during the traumatic event. This can happen when people are in a relationship or when they are friends or family members.

The Somatic Symptom Disorder Test is a tool that can be used to help diagnose somatic symptom disorder. It is a self-report measure that includes questions about the frequency and severity of somatic symptoms, as well as the impact of these symptoms on daily functioning.

A tertiary trauma survey is a comprehensive assessment of all injuries sustained by a patient in a major trauma event. It is typically performed by a team of specialists in the emergency department or trauma center. The survey includes a thorough head-to-toe examination, with special attention to any life-threatening injuries. All patients who undergo a tertiary trauma survey should be closely monitored for any changes in their condition.

The Sexual Minority Patient Satisfaction Survey (SMPSS) can be used to assess the level of satisfaction of sexual minority patients with their healthcare providers.

This medical release form will allow you to authorize another person to receive medical information about you from your healthcare provider.

The Health History Questionnaire is a tool used by healthcare professionals to collect information about a patient’s health.

A health evaluation form is a document that is used by healthcare providers to assess the health of an individual. The form includes questions about the individual's medical history, family medical history, current health status, and lifestyle.

The Medical Product Evaluation Form is used to assess the safety and efficacy of a new medical product. This form is used by medical professionals to provide feedback on the product’s performance.

The nutrition evaluation form is used to assess the nutritional status of an individual. These forms help to identify individuals who are at risk for malnutrition or who may need nutritional intervention. Nutrition evaluation forms can be used to screen for malnutrition, assess the adequacy of nutrient intake, and monitor changes in nutritional status over time.

A sperm donor application form is used by sperm banks and fertility clinics to collect information from prospective donors. The form typically includes questions about the donor's medical history, genetic history, and personal information. The form will also ask for information about the potential donor's sperm, including the donor's sperm count, motility, and morphology.

Informed consent forms for sperm donors are used to provide potential donors with information about the risks and benefits of donating sperm. The forms should include information about the potential risks of sperm donation, such as the risk of transmitting genetic diseases, the risk of exposing the donor to sexually transmitted diseases, and the risk of legal liability. The forms should also explain the potential benefits of sperm donation, such as the ability to help infertile couples have children.

This is a consent form for egg donors. It includes information about the risks and benefits of egg donation, as well as the donor's rights and responsibilities.

An IVF consent form is a legal document that outlines the terms and conditions of undergoing in vitro fertilization treatment. The form should be read and signed by both the patient and the doctor prior to beginning treatment. The form should include information about the risks and potential complications of the procedure, as well as the patient's rights and responsibilities.

This survey is about abortion. It asks questions about people's opinions on abortion and their personal experiences with abortion. The survey is confidential and all responses are anonymous.

Abortion consent forms are legal documents that are used to document an individual's decision to undergo an abortion procedure. The forms typically include information about the individual's medical history, the risks and benefits of the procedure, and the individual's right to withdraw consent at any time.

The Planned Parenthood consent form is a document that patients must sign in order to receive care at a Planned Parenthood health center. The form outlines the type of care that the patient will receive, as well as the risks and benefits of the procedure. The form also explains the patient's rights and responsibilities, and gives the patient the opportunity to ask questions and get more information about the procedure.

The Planned Parenthood abortion form is a document that is used by patients who wish to terminate their pregnancies.

The Abortion Form is used by healthcare providers to document the care and treatment of a patient who has had an abortion. The form usually includes the patient's demographics, medical history, and the type of abortion procedure that was performed.

A patient rights Form is a document that outlines the rights of patients in a healthcare setting. It is important for patients to be aware of their rights so that they can be treated with respect and dignity. The form should be made available to patients upon their arrival at the healthcare facility.

The secondary survey in trauma is a more detailed assessment of the patient that is performed after the initial assessment and stabilization. It includes a thorough head-to-toe exam, looking for any additional injuries that may have been missed. It also includes a more detailed history taking, to get a better understanding of the mechanism of injury and the events leading up to the present.

The primary survey assesses the patient's ABCs—airway, breathing, and circulation—and is performed as soon as the patient arrives in the emergency department. The primary survey aims to identify and correct any life-threatening problems. Once the patient's ABCs have been stabilised, a more thorough secondary survey can be performed.

This sample Confidentiality Agreement Form is suitable for use with individuals and businesses and ensures that all information obtained by the disclosing party (Individual or Organisation) is kept private and confidential.

A patient consent form is a legal contract between the patient and healthcare provider.  It helps formalize the relationship between the parties involved, provides assurance of informed consent about medical treatment, and protects both parties in case of litigation relating to medical treatment. This document should be signed by the patient, allowing the clinician to provide services, but it does not obligate them to do so.  The signature may take place electronically (for example via a digital tablet) or this may be done in writing on paper.

Template for Contact Tracing will help track down people who are in danger of being exposed to the virus.

A dental, medical history form is a document that the patient fills out. The dentist next uses this information to assess if any pre-existing conditions could interfere with basic dental operations. The patient must fill out this information because patients will most likely be sedated and in a semi-conscious state during a visit to the dentist. All information pertinent to the individual's current situation should be recorded.

Screening Survey is a short questionnaire that can help you determine if you should be tested for the coronavirus.

Every office has a different intake form but most will be similar in the sense that they want to gather patient information like: patient's name, address, contact info, reasons for visit, medications currently taking, and/or any medical history regarding past symptoms.

A medical history form is a questionnaire that asks a patient to fill out information on their family's medical ailments, previous illnesses or procedures, and other issues that may affect treatment. This type of medical form is necessary in a variety of fields, including academia and research, as well as healthcare.

A request for medical records form includes details about the patient, doctor, and any information regarding the medical records that are being requested. A request for medical records is used when a patient needs to be updated on the current condition of his or her health. Patients may request medical records directly from their doctors, but most often they will contact their hospital, physician office, or other caregivers in order to release the information. These forms are under the protection of the Health Insurance Portability and Accountability Act (HIPAA).

The sample mental health assessment form is meant to give you an idea of how a professionally designed mental health assessment form may look and serve as a guide. When you are concluding your mental health assessment form, always make sure that it has enough space for gathering all the information you will need about the patient’s mental state of mind.

Sample template: self declaration health form