Medical History - Figure 2.11

Use the information you used for the “Patient Registration” activity to fill in this medical history for the patient you created. Invent past conditions, allergies, and medications for your patient and his or her family members.

Sun View Medical

Medical History Form

Have You Had: YES / NO   YES / NO   YES / NO

Family Health History (List father, mother, siblings, spouse/partner and children)
Family Member Age If no longer living, cause of death and age of death

Has any family member ever had:
(parent, sibling, or grandparent) YES/NO Relationship YES/NO Relationship