Would you like to have hard copies of this patient history form?

(Edited)

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Useful form.One should get it filled in,may be more elaborative and specific like Hypertension and its medications getting,History chest pain,giddiness,syncope etc.HIV/AIDS and other venereal diseases,deliveries total number-normal and surgical like caesarean,forceps etc.No of living children.H/O abortion and MTPs.Height/Weight/Built thin,average or obese etc.Profession as certain professions demand red alert for doctors eg judge,lawyers where we have to become more careful and ultra-selective.

Good proforma but devoid of physical examination by clinician and space for investigations advised or b/b pt and lastly the provisional dx and mx advised

Fully agree with you Sir.
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Yes, nicely drafted but not possible in semi urban and rural areas.

Thanks Dr Umama Sayyed.
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Nice initiative.. May i suggest for the clinical examination details because thats the only thing which is difficult to interprit on curofy..

Needs much more pt related info to be included like important positive and negative past h/o,family history, h/o surgery, h/o medical treatment etc

Indeed nice

Thanks dear US mem
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Good performa to be answers fillel by patient signed by him and doctor or submission of patients history in his(her) answers .

I do use such form preoperatively provided by micro vision

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