Medical History With All Current Medications
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1MEDICAL HISTORY
Name:
Date:
ALL CURRENT MEDICATIONS YOU’RE TAKING:
Name of Med
Milligrams
Times of Day Taken:
How Long Taken:
Who Prescribes? For What Condition?
What Medications Have You Taken in the Past for Anxiety, Depression, Sleep Problems, ADD/ADHD, etc?
What Medical Conditions Do You Have Now?
What Injuries Have You Experienced?
In addition to Medications, are you undergoing any regular medical procedures?
What Surgical Procedures Have You Had
When?
What Are Your Allergies?
What Medical Conditions Run In Your Family?
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Parent category: Medical