Past History

Childhood illnesses, such as measles, rubella, mumps, whooping cough, chicken pox, rheumatic fever, scarlet fever, and polio are included in the Past History. Also included are any chronic childhood illnesses. You should provide information relative to Adult Illnesses in each of four areas: Medical (such as diabetes, hypertension, hepatitis, asthma, HIV disease, information about hospitalizations, number and gender of partners, at-risk sexual practices); surgical (include dates, indications, and types of operations); Obstetric/gynecologic (relate obstetric history, menstrual history, birth control, and sexual function); and Psychiatric (include dates, diagnoses, hospitalizations, and treatments). You should also cover selected aspects of Health Maintenance, including Immunizations, such as tetanus, pertussis, diphtheria, polio, measles, rubella, mumps, influenza, hepatitis B, Haemophilus influenza type b, and pneumo-

Ûoccal vaccines (these can usually be obtained from prior medical records), nd Screening Tests, such as tuberculin tests, Pap smears, mammograms, stools )r occult blood, and cholesterol tests, together with the results and the dates ley were last performed. If the patient does not know this information, writ-en permission may be needed to obtain old medical records.

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