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Health assess 3

Health History

Past Health Childhood illnesses - measles mumps, rubella, chicken pox
Accidents or injuries Serious or Chronic illness- diabetes, hypertension
Hospitalizations and Surgeries number of pregnancies
G P Ab Liv gravidity, parity, imcomplete pregnancies/abortions, and number of living children G4,P3,Ab1,Liv3
Immunizations all childhood immunizations, last tetanus, TB and flu shot
Last exam date most recent physical, dental, vision, hearing, any chest xrays etc
any known allergies Medications, foods, environmental - note ractions
Current medications includes all Rx, OTC, birth control, laxatives, vitamins, aspirin, antacids
Created by: Hazlett5