A DOH (department of health) health record template is a prewritten document which acts as a health record template for many hospitals or individuals to keep a record of their medical history. There can be various different types of DOH Health record templates which one can be used as per their needs and requirements. The DOH health record template is one document which helps health institutes to get a proper health record form which has a well detailed and outlined structure and the right composition of the content. The users just need to modify the template to suit their specifications and needs. The fact that these templates can be customised makes them very popular and thus widely used by a lot of people. Given below is a sample of a DOH health record template.
“You can Download the Free DOH Health Record Template form, customize it according to your needs and Print. DOH Health Record Template is either in MS Word, Excel or in PDF.”
Sample DOH health record template
DOH health record template
Download DOH health record template
Name: _________ [mention the name of the person whose health record is being made]
Sex: __________ [male/female]
Age: __________ [write the age]
Date of birth: ________ [dd/mm/yy]
Starting date of health record: _______ [dd/mm/yy]
Termination date of health record: ____________ [dd/mm/yy]
Details of List of appointments:
Date physician/phone number reason for visit
[Make a list of all appointments with all the doctor’s visited during the health record period]
Details of Personal habits:
Do you do the following, answer in yes or no:
Drink alcohol: ________ [yes/no]
Currently smoke: _______ [yes/no]
Exercise: _______ [yes/no]
Take any sleeping pills: _______ [yes/no]
Keep a check on weight: ______ [yes/no]
Details of Allergies:
Date: Allergic to? Symptoms and reactions
[Make a list of all the allergies and their symptoms and reactions date wise]
Health history
Condition: [Yes/no] Medication used When were you diagnosed
Cancer, type
Stroke
Cholesterol
Asthma
Depression
Chronic conditions
Heart disease
Diabetes
High /low blood pressure
Medications:
Drug name dosage directions Purpose date started
[Make a list of all medications used and all the other details in the columns given]
List of surgeries/ailments:
Surgery name Body part affected when
[Make a list of all the surgeries you have undergone and how they affected you]
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