Gathering Your General Medical Information

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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

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