Patient Health History Questionnaire

Knowing a patient’s health history is critical for doctors, as it is their responsibility to give the right type of treatment to patients. Healthcare practitioners cannot suggest any treatment unless they know about the medical history of the patient. Therefore, a form is used when a patient shows his willingness to get the treatment.

What is a patient health background questionnaire?

It is a document that enables the medical staff to know about the things they need to ask the patient regarding his background. Usually, the patient is given this form to fill out at the time of registration. Doctors are not present there, and ordinary staff have to deal with them, and they usually don’t know what to ask the patient. So, they are given a form to fill out, which contains a few questions to be asked. It is an essential tool for healthcare professionals who want to choose an effective treatment plan for the patient.

What should I include in the questionnaire?

The form that contains information about health history is usually very personal to every hospital. The data collected is not shared with anyone. However, hospitals often use the same form if they get access to the ready-made document. Some hospitals also contain a form on their own that contains those elements that are necessary and helpful for them to treat the patient. Here are some of the main details to be included:

Header section:

This document has a header section on its top that gives the reader a brief introduction to the form. Patients who are giving their details often want to know about their medical background and how it works. Therefore, it is important to include the header section, in which there should be the following details:

  1. Name and logo of the hospital
  2. Title of the form
  3. A statement that lets the person filling out the form know that the information provided in this form will remain confidential and the hospital will use it only for treatment purposes This gives patients peace of mind that their information will be in safe hands.

Basic details of the patient:

Under the header section, some basic questions are asked, such as the name of the patient, date of birth, gender, name of the doctor who referred the patient, occupation, etc.

Personal health history:

Questions regarding the health history of the patient are asked. They usually start with the illnesses that have been affecting the patient since childhood. There are different diseases or allergies that people catch in childhood, and then they stay with them forever. Therefore, they should report those allergies that they caught when they were young.

Details regarding immunization:

The form also collects information regarding the immunization of the patient. Here, the patient has to tell the name of the disease for which he has been vaccinated. In many cases, the health of the patient largely depends on the efforts he has put into his life to protect himself from several diseases through immunization.

Hospitalization details:

The form asks the person how many times he has been hospitalized. There is a space where the patient has to mention the reason for hospitalization. If he remembers, he can mention the name of the hospital where he got the treatment. The year in which the treatment was obtained can also be mentioned.

Disease history:

The form includes a checklist of the diseases, and the patient is asked to check those diseases that he is suffering from or has suffered from in the past. Healthcare practitioners find it important to treat patients who are aware of their health. For instance, if a person has hypertension and diabetes, he will be given the treatment carefully, as hypertension and diabetes can cause lots of problems if they are not taken into account.

Description of prescribed drugs:

The patient is also asked to mention the names of the drugs that he has been prescribed by his doctor. Some medications also have an impact on the medical condition of the patient, and doctors need to take the formula of the medicine into account before prescribing another medication, as two different formulas can have a negative reaction in the body.

Patient Health History Questionnaire template

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