free medical history form template

free medical history form template

free medical history form template

one place for your diagnoses, dates, treatments and allergies, so you stop rebuilding your history from memory at every new appointment.

one place for your diagnoses, dates, treatments and allergies, so you stop rebuilding your history from memory at every new appointment.

opens your print dialog. choose "save as PDF" to keep a copy.
Roxname / week: ________________

personal medical history

include surgeries, hospital admissions, allergies and anything still unresolved. bring a copy to any new clinician.

condition or eventyeardiagnosed bytreatmentcurrent statusnotes

free worksheet from rox · talktorox.com · not medical advice

Rox mascot

rather not keep paper?

rather not keep paper?

the free symptom tracker does the same job in your browser and works out the patterns for you. rox is the free ios app behind it: it remembers every entry, reads your apple watch, oura, garmin or amazfit, and builds a summary a doctor can read in a minute.

how to use it

Every new clinician asks for your history, and rebuilding it verbally each time is slow and lossy. Writing it once and updating it is one of the highest-value hours you can spend with a complex condition.

Include what is unresolved, not only what was diagnosed. Investigations that came back normal are useful information too, because they stop the same tests being repeated.

questions? we have answers.

questions? we have answers.

01

what should a personal medical history include?

diagnoses with rough dates, surgeries and hospital stays, allergies and reactions, current and past treatments, and anything still under investigation. approximate years are fine and far better than leaving gaps.

02

why keep my own medical history?

because records are scattered across practices and specialists, and nobody holds the whole picture except you. a single current page prevents repeated tests and speeds up every first appointment.

03

how often should i update it?

after any new diagnosis, treatment change or hospital visit, and always before seeing someone new. a quick review every few months keeps it from drifting out of date.

free to use, print and share. rox is a tracking tool, not medical advice, and it cannot diagnose or treat anything.