Patient History Questionnaire - Ucla Health System

The Patient History Questionnaire used by the UCLA Health System is designed to gather comprehensive information about an individual's past and present health. This includes a range of fields encompassing personal medical history, family medical history, lifestyle factors (like diet, exercise, smoking, and alcohol consumption), and current symptoms or health concerns.

This document is vital in helping medical professionals at UCLA understand the overall health of their patients, identify potential health risks, and guide decisions relating to diagnosis and treatment. By providing a broad picture of the patient's health and lifestyle, the questionnaire allows for more personalized, efficient, and effective care.

The Patient History Questionnaire at UCLA Health System is typically filled out by the patient themselves. In cases where the patient is unable to do so, a caregiver, family member, or legal guardian may fill it out on their behalf. This form contains important medical history information that the doctors at UCLA Health System use to provide a comprehensive and personalized medical care plan.

FAQ

Q: What is a patient history questionnaire?
A: A patient history questionnaire is a form of document used by healthcare professionals to gather detailed information about a patient's past medical history, including illnesses, surgeries, and lifestyle choices. It helps to provide a complete picture of a patient's health and risk factors.

Q: What is the purpose of a patient history questionnaire in UCLA Health System?
A: The purpose of a patient history questionnaire in UCLA Health System is to provide doctors with necessary information about a patient’s medical history, lifestyle, and current symptoms. This data helps physicians to make accurate diagnoses and develop effective treatment plans.

Q: What kinds of questions are commonly asked in a patient history questionnaire?
A: Common questions in a patient history questionnaire may include: Do you have any chronic diseases such as diabetes or heart disease? Have you had any major surgeries or injuries? Do you smoke or drink alcohol? Do you have any allergies? What medications are you currently taking? And many more related to the patient's health history and lifestyle.

Q: How often should I complete a patient history questionnaire?
A: You might be asked to complete a patient history questionnaire before your first appointment with a new healthcare provider, or if you haven't been to see your current provider in a while. Additionally, you might have to update it if your medical condition changes or if you have a new diagnosis or procedure.

Q: Is the information provided in the patient history questionnaire kept confidential at UCLA Health System?
A: Yes, the information you provide in a patient history questionnaire is kept confidential as per the Health Insurance Portability and Accountability Act (HIPAA). The UCLA Health System is committed to maintaining the privacy and security of personal health information.