Health History Template

A Health history template is a readymade format of a document that helps to find out the medical history of an individual. These types of templates prove to be helpful in treating an individual for any particular disease or ailment and finding out the possible risks if any. The nature of the template is such that it has the major points or headings needed and the rest of the details have to be filled by the users to record their health history. Such documents are useful for many health organisations as they are easy to use and almost free of cost. Such templates generally follow a strict and formal format and thus users or medical associations do not need to worry about getting the structure right.

“You can Download the Free Health History Template form, customize it according to your needs and Print. Health History Template is either in MS Word, Excel or in PDF.”

Sample Health History Template

Health History Template

Download Health History Template

Name _____________ [the person’s name]

Address ______________ [address of same]

Date of last medical test _________ [(dd/mm/yyyy) date needs to be filled]

Name of physician___________ [mention his/her name]

Address ____________ [mention address of same]

Immunisations taken __________________ [mention each immunisation taken]

Last date of immunisation_________________ [mention the date of each]

Medicines needed and why _________________ [name the medicines that you consume and the ailment]

Any current health risk ___________________ [mention the disease, if any]

Any previous elaborate medical treatment taken _______________ [mention past treatments]

Any allergies ______________ [fill your allergies]

Dietary restraints________________ [mention any food related restriction]

Any mental or psychological ailment _______________ [mention if any mental illness]

Medicines needed _______________ [mention the drug used]

Signature _________________ [sign of the applicant]

Date __________dd/mm/yyyy______

Category: Health Templates

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