Page 18 - Hospitalists - Risks When You're the Doctor in the House (Part Two)

SVMIC Hospitalists - Risks When You’re the Doctor in the House

Comprehensive Medical History
*Patient’s past history of illnesses, injuries &
Patient Name Address treatments, prior operations, hospitalizations, current
Date of Birth/Age Telephone Number medications, age-appropriate immunization
information, feeding, dietary status
Gender Insurance Carrier Comprehensive Family History
Marital Status Financial Contact *Health status or cause of death of patient’s family
Identification Number Emergency Contact members, including specific hereditary diseases that
may place patient at risk
Comprehensive Psychosocial History
*Significant information about patient’s activities and
other relevant social factors (e.g. marital status, living
arrangements, employment, use of drugs, alcohol,
tobacco, level of education, etc.)

Listing past & present medical regimens
(including OTC) & indicating drug allergies,
sensitivities, or adverse reactions

Dictated or legibly-written in
SOAP or other problem-oriented
form for each patient visit

Page 18