Over the next few months, we will be releasing various medical forms for use by RV’ers. These forms will provide needed information to the physician, clinic, hospital, or emergency room and will save you aggravation and time. When you are ill or injured, you aren’t always able to tell the nurse or physician your medical history, allergies, surgeries, medications, and other vital information. Even if it is only a minor problem, no one wants to sit around filling out page after page while they wait.
These medical forms will eliminate many of the delays you encounter when seeking medical care. Especially if you are traveling and need to go to a medical facility for the first time.
How To Use Medical Forms:
Download the form to your computer, phone, or tablet.
If you decide to use the form, print the form on your printer. Keep the downloaded from on your device in case you need to print it again in the future.
Complete the form with your information.
Make a copy of the completed form as you will give the medical facility this copy if you need to seek medical care. They may or may not return this copy to you.
Don’t forget! Update the form if there is new medical information.
HERE IS A LISTING OF DOCTORS IN RVS HEALTHCARE FORMS COMING SOON. Note: Some of the forms are only available to premium subscribers.
Authorization For Release of Health Information
This is a medical record release. Complete this form to obtain a copy of your medical record or to have a copy sent to your physician or the person of your choice.
Contact Information
This form provides your contact information along with your current and future RV locations.
Medical Contact Information
Medical contact form contains name, address, phone information of physicians, pharmacies, hospitals and clinics and emergency contacts.
Medical Demographics and History
This form contains information on patient, guarantor, pharmacy, insurance, surgical history, past medical history, family history, education, use of tobacco, alcohol, caffeine, drugs; obstetric/gynecological history, consent to contact, communication preferences, disclosure to family members, privacy practices.
Medical History Long Form
A form with medical history, ob/gyn history, surgical history, hospitalizations, family history, social history (alcohol, tobacco, etc), medications, allergies, immunizations, health maintenance and screening tests, review of systems.
Medical History Short Form
A form with medical history, surgical history, hospitalizations, family history, social history, medications, allergies, immunizations.
New Patient Form
Patient information, emergency contact, employer, insurance, current medical problems, obstetric and gynecological history, surgical history, allergies, medications, past medical history, family history, education; tobacco, alcohol, caffeine, drug use; financial policy and authorizations, consent to contact, notice of privacy practices, patient communication consent, disclosure to family members.
New Patient Dental Form
A Dental Form. Patient information, guarantor, emergency contact, payment information, dental history, medical history, illnesses and symptoms, allergies, agreement.
New Patient Registration
Patient information, name, address, date of birth, emergency contact, pharmacy, marital status, employer, gender, etc.
Communication Consent Form
A form with notice of privacy practices, communication consent, disclosure to family members.
Patient Demographics Form
Patient information, name, address, birthday, gender, marital status, employer name, insurance information, insurance, HIPAA acknowledgment and consent form.
New Pediatric Patient Form – 6yrs and Up
Pediatric form for children 6 years of age and up. Patient information, birth history, medical history, family medical history, authorization for consent to medical care and treatment.
New Pediatric Patient Form – Newborn to 6yrs
Pediatric form for children from newborn to 6 years of age. Patient information, birth history, medical history, family medical history, social history, authorization for consent to medical care and treatment.
Emergency Contact Form
(Previously released on this site) This form contains contact information for emergency situations.
Blood Sugar Record
This form is to record your blood sugar measurements with dates and times.
Blood Sugar and Vital Signs
This form expands on the blood sugar form with the addition of blood pressure, pulse, respirations, and temperature.
Medical History
A form with medications, allergies, diagnoses, surgeries; alcohol, tobacco, drug use.
Medical and Systems Review
This form contains extensive information. Completing this form prior to your medical visit will eliminate many questions you are asked.
Medical History Short Form - Available today for Free and Premium Subscribers.
Our many medical articles and forms are available for downloading at:
or
https://alfredricksjrmd.kartra.com/page/JGC119
The free articles and forms are available to everyone. Monthly or yearly premium subscribers receive a large discount off the forms requiring purchase. Premium subscriber will find the discount coupon code in the most recent “Monthly Discount Code” posting.
New Patient Form - Available today for Premium Subscribers
Medical History Long Form - Available today for Premium Subscribers
