Gathering Your General Medical Information
Your personal medical history should include basic information about you, including:
- current legal name and any other names you may have used in the past
- birthday
- blood type
- height and weight
- amount you exercise per week
- list of vitamins/supplements you take, including dose
- people to contact in case of an emergency, including home, work, and mobile phone numbers; home and work addresses; and e-mail addresses
- allergies (including foods, animals, and medicines)
- glasses or contacts wearer, if applicable
- health insurance information, including name and social security number of primary person insured if it isn't you
- current list of immunizations and dates given
- routine test results (cholesterol, blood pressure, blood sugar)
- family doctor's name, address and phone number
- hereditary conditions in your family history
- list and dates of significant illnesses and treatments besides breast cancer (include childhood diseases such as chicken pox, mumps, etc.)
- current medicines taken and dose
- eye and dental exam records
- living will, advance directives or medical power of attorney, if applicable
- organ donor authorization, if applicable
