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Patient Medical Questionnaire for Meaningful Use

Ensure you are collecting the necessary information to meet Meaningful Use!

Patient Medical QuestionnaireFor a lot of doctors, Meaningful Use is complicated. There are a lot of measures to meet and they often weigh out the pros and cons of attempting to attest. Unfortunately, by choosing to ignore Meaningful Use, you not only lost out on incentives but now you are facing potential penalties that can financially impact your practice. Taking simple steps to educate yourself or finding a knowledgeable EHR provider can make Meaningful Use simpler than ever.  To help you with some simple aspects of Meaningful Use, we're addressing some of the most basic measures, capturing patient medical history. To meet Meaningful Use, doctors must document certain patient medical information for a percentage of their patients. This information includes demographics and basic medical history. While it may seem simple, there are often gaps of missing information that result in missing certain measures. We want to help make it simple by providing an example of a medical history questionnaire. With a simple form you can help ensure you're collecting the necessary patient information so that you can easily meet these Meaningful Use measures.

Breaking It Down

A lot of practices utilize a patient medical history questionnaire as a method by which they can collect all the necessary information from their patients. A majority of the information on this form is not only beneficial for the doctor but it is necessary to track for Meaningful Use attestation. The information collected here can then be input into an EHR system for accurate tracking. For some, this may be a paper form, and for others it may be filled out online or on a mobile tablet or device. Use this form in whichever method is most suitable for your office.

Medical History Questionnaire Includes:

Demographics – Basic patient information

Allergies – current allergies, reaction and severity

Past Medical History – significant medical issues, past surgeries

Past Ocular History – significant ocular issues, past surgeries

Medications – current ocular and systemic medications

Family History – Significant medical history of immediate family

Social History – smoking, drugs and alcohol use

Click here for Medical History Questionnaire

Download the questionnaire and begin putting it to use in your practice today. Each section of the form applies directly to a different measure in Meaningful Use.

Please Note: Meaningful Use measures and requirements can change. The example form provided is not guaranteed to be accurate or appropriately meet Meaningful Use as it does not address every measure. It is simply provided as a reference to start collecting your information.

One response to “Patient Medical Questionnaire for Meaningful Use”

  1. Debrah says:

    If my problem was a Death Star, this article is a photon todpore.

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