Patient Information
________________________ First Name:______________ Last Name:______________ What is your real, birth name? ______________________________ Where and when were you born? ______________________________ How old are you? ______________________________ What is your Email address? ______________________________ What is your mailing address? ______________________________ What has been your mailing address from the time of your birth until now? ______________________________ What language do you speak? ______________________________ What is your height? ______________________________ What is your weight? ______________________________ What is the color of your skin? ______________________________ What is the color of your hair? ______________________________ | ||
Lifestyle Information
______________________________ Do you smoke? ______________________________ Do you use alcohol? ______________________________ Do you abuse any drugs? ______________________________ | ||
| Contraceptive history | ||
| Children | ||
| Diet | ||
| Ethics | ||
Emergency
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| Family History | ||
| Family-Centered Maternity Care-Pregnancy | ||
| Female Medical History | ||
Human Pregnancy
Here are further guidelines. | ||
| Menstrual history | ||
| Menstruation | ||
| New Patient Consultation | ||
| Obstetric history | ||
| Obstetrics & Gynecology History | ||
| Prenatal care Personality questions | ||
| Previous Pregnancies | ||
| Planning for pregnancy (Parenting Advice) | ||
Problem/Complaint
History of Present Pregnancy History of Present Illness | ||
| Past medical history | ||
| Physician Details | ||
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Pregnancy (Initial profile) 1st Trimester 2nd Trimester 3rd Trimester | ||
| Provisional Diagnosis | ||
Pets
Domestic pets, Dogs, Cats, Birds, Farm animals. | ||
| Sexual Health (Health & Sex.) |
| Annual health assessment of children. |
| Acquired harms |
| Birth History |
| Birth Defects |
| Pediatrics. |
| Hospital Patient |
| Hospital |
| Hospital Medical Record |
| Cardiology |
| Psychiatry |
| Gastroenterology |
| Disability Specialist |
| Geriatrics |
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Medical record Medical history |
| Medical law |
| Patient Profile |
| Aisha (mummy) |
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Who should maintain electronic health records? The state department of health. A medical doctor and his or her team. How often should electronic health records be updated? Electronic health record should be updated as soon as new findings are available. What is the medical history of a patient? The medical history of a patient is a longitudinal record of what has happened to the patient since birth. What is the difference between medical history, medical record, electronic health record, and emergency medical record? If you have a new patient, you have to get his or her medical history since birth. This is medical history. Once this medical history is maintained in any format (paper, electronic), this becomes a medical record. A medical record preserved via the Internet is an electronic health record. All facts gathered during a medical emergency become an emergency medical record. Did you know that 90% of doctor visits are for stress related symptoms? How many human medical conditions are there? There are more than 7,000 human medical conditions. Why should you call them medical conditions instead of diseases? Diseases usually indicate an underlying pathology. Not all medical conditions have an underlying pathology. How many medical conditions are caused by stress? More than 100 medical conditions are the result of stress. These are the most common medical conditions. Why is there a need to elaborate on life stressors? Life stressors are most common cause of various common medical conditions. |
| Medical Doctor |
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Is this complaint about your health or someone else’s? What best describes the complaint about your health? New Patient Consultation http://www.qureshiuniversity.com/medicalhistory.html Medical emergency http://www.qureshiuniversity.com/medicalemergency.html What are the sources of medical history? Patient. Family. Patient not responding to medical history questions. Community member. Police officer. Referral from medical doctor. Other. What are various emergency guidelines for the public? http://www.qureshiuniversity.com/emergencyguidelinesforthepublic.html Who has the medical record of the patient? What should a medical record of a patient look like? Who should update the medical records? How is a medical record maintained? Electronic medical record. Medical records in paper format. Emergency medical record. What should a medical record contain? What should an emergency medical record contain? What are the scenarios in which medical records can be obtained? Routine requests for medical records. Legal proceedings or in response to a request to release patient medical records. Court. Updating the medical records. Workers in Health Care What are various workers in health care? http://www.qureshiuniversity.com/workersinhumanhealthcare.html |
| How should you communicate with your medical doctor? |
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Who is your primary care physician, medical emergency resource, Internet health care resource? This should be communicated to the residents in the state. Internet health care resource for the resident. Primary health care physician for the resident. Medical emergency resource for the resident. |
| What should be the priority of the health care system? |
| GYN HISTORY |
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What are various methods to list a medical record?
How should every state department of health maintain medical records of all residents? In alphabetical order. Based on specific pattern or institution. A medical record in alphabetical order is preferable. |
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Address Activities of everyday living Annual health assessment Assets Abilities/skills Complaint/problem Communications Duties Detention Education Hospitalization Language Photograph Profession Referrals Survival Needs Stress Travel history What is your name? _________________________ What is your date of birth? _________________________ Where and when were you born? _________________________ What is your gender? _________________________ Address What is your mailing address? ________________________ ________________________ ________________________ ________________________ Where are you located now? ________________________ What was your mailing address from birth until now? _________________________ _________________________ _________________________ _________________________ Where do you live now? _________________________ How long have you lived at this address? _________________________ What is your contact information including current mailing address, telephone, e-mail, and any other details, and person to contact in case of emergency? _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ How long do you plan to live at this address? _________________________ Activities of everyday living What is your normal day like? _________________________ What do you normally enjoy doing? _________________________ Annual health assessment When was your last annual health assessment done? _________________________ Who did your last annual health assessment? _________________________ What were the findings? _________________________ What were the recommendations? _________________________ Did the recommendations help? _________________________ Was it an annual health assessment or evaluation of a new problem? _________________________ When did you last see a medical doctor? _________________________ Did you see a medical doctor for an annual health assessment or a new problem? _________________________ What seemed to be the problem? _________________________ What was the diagnosis and treatment? _________________________ What is the name and contact information of the medical doctor who gave you this diagnosis and treatment? _________________________ Assets What are your assets? _________________________ Abilities/skills What are your abilities and skills? _________________________ Complaint/problem Do you have any complaint/problem relevant to human health care today? _________________________ If you have any complaint/problem relevant to human health care today, what are the details? _________________________ How are you feeling today? _________________________ Do you have any problems today? _________________________ What seems to be the problem? _________________________ _________________________ _________________________ _________________________ _________________________ Communications What is the best method to communicate with you? E-mail. Fax. Telephone call. Postal mail. Communication through media. _________________________ Duties Do you have any duties? _________________________ Who assigned you these duties? _________________________ Detention Were you ever detained or jailed? _________________________ How many times and how long were you detained or jailed, and what were the reasons? _________________________ Do you think your detention and/or being put in jail was justified? _________________________ What concept of law is applicable to this scenario? _________________________ Education How would you rank you education level? _________________________ Is you educational level at primary school, middle school, high school, associate’s degree, bachelor’s, master’s, or doctoral degree? _________________________ What subjects have you studied? _________________________ What profession have you studied? _________________________ What are your abilities? _________________________ What services can you provide? _________________________ Have you designed or developed any products and services? _________________________ What are the issues? _________________________ Did your parents/guardians and school raise you with liberal values, religious values, or some other values? _________________________ How were you raised? _________________________ What best describes your English language abilities? _________________________ What details should I know about you now that might later create problems for me, you, and others? _________________________ What are your goals or plans? _________________________ Hospitalization When was the last time you were hospitalized? _________________________ What were the reasons for hospitalization? _________________________ How long did the hospitalization last? _________________________ Do you think the hospitalization was justified? _________________________ Language Do you understand, speak, read, and write the English language? _________________________ What languages can you understand, speak, read, and write? _________________________ Photograph Where is your recent photograph? _________________________ Where and when was this photograph taken? _________________________ Where is your state ID with a photograph? _________________________ Profession What profession do you identify with? _________________________ Referrals Did anyone refer you to this resource? _________________________ Did the referring resource provide any referring document? _________________________ Who referred you? _________________________ What are the details of referral? _________________________ Survival Needs Has the state provided you enough survival needs? _________________________ Stress Do you feel stressed now? _________________________ What are normal complaints, symptoms, and signs of stress? _________________________ Do you have any of the complaints, symptoms, and signs of stress listed? _________________________ What do you think is the cause of your stress? _________________________ Did you know that 90% of doctor visits are for stress related symptoms? _________________________ What do you know about stress? _________________________ Write down any symptoms you're having, including any that may seem unrelated to the reason for which you scheduled the consultation. Note when your symptoms bother you most — for example, if your symptoms tend to get worse at certain times of the day, during certain seasons, or when you're exposed to cold air, pollen or other triggers. _________________________ _________________________ _________________________ Write down key personal information, including any major stresses or recent life changes. _________________________ _________________________ Make a list of all medications, vitamins and supplements that you're taking.Take a family member or friend along, if possible. Sometimes it can be difficult to recall all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot. _________________________ Write down questions to ask your doctor. _________________________ What are the sources of medical history? _________________________ Patient. Family. Patient not responding to medical history questions. Community member. Police officer. Referral from medical doctor. Other. Where is the patient now? _________________________ Travel history Where have you travelled up to now in North America, Asia, Africa, Australia, Latin America, or Islands even for one day? _________________________ These are basic questions. There are many more. |