
Download and save the form below and put it to work in your practice today. Already have one? Take a look and see if there’s anything you are missing![/vc_column_text][vc_cta_button2 h2=”Download the Medical History Questionnaire” style=”rounded” el_width=”80″ txt_align=”left” title=”CLICK HERE” btn_style=”rounded” color=”black” size=”lg” position=”right” accent_color=”#d93227″ link=”url:http%3A%2F%2Ffoxfiresg.com%2Fwp-content%2Fuploads%2F2015%2F08%2FFoxFire-Medical-History-Questionnaire.pdf|title:FoxFire%20Medical%20History%20Questionnaire|target:%20_blank”] [/vc_cta_button2][/vc_column][/vc_row][vc_row css=”.vc_custom_1439392328375{border-right-width: 3px !important;border-left-width: 3px !important;padding-right: 100px !important;padding-left: 100px !important;border-color: #d93227 !important;border-style: solid !important;}”][vc_column width=”1/1″ css=”.vc_custom_1439392360812{margin-top: -50px !important;}”][vc_column_text]
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.
[/vc_column_text][/vc_column][/vc_row][vc_row css=”.vc_custom_1439392181234{border-right-width: 3px !important;border-bottom-width: 3px !important;border-left-width: 3px !important;padding: 20px !important;background-color: #ffffff !important;border-color: #d93227 !important;border-style: solid !important;}”][vc_column width=”1/2″ css=”.vc_custom_1433972599651{margin-top: -20px !important;padding-right: 20px !important;padding-left: 20px !important;}”][vc_ff_title el_type=”h3″ align=”left” title=”Breaking It Down”][vc_column_text]A lot of practices utilize a 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[/vc_column_text][vc_column_text]If you have more questions about Meaningful Use or want to see how FoxFire EHR can make it simple, fill out the form and a representative will reach out to you as soon as possible![/vc_column_text][/vc_column][vc_column width=”1/2″ css=”.vc_custom_1439312473095{margin-top: 35px !important;border-left-width: 5px !important;padding-left: 20px !important;border-color: #d93227 !important;border-style: solid !important;}”][contact-form-7 id=”5422″][/vc_column][/vc_row]