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