Vaccination and Heath History Record

I hate filling out medical history forms.  I find it to be very tedious.  At every new blank, I end up either searching through a file folder with about 200 papers in it, googling a phone number or address, or digging through my wallet to copy information from my insurance card or ID.  

The problem has been complicated for me since I've moved several times in the past five years, switched jobs, switched insurance companies, and switched doctors and dentists.  Needless to say, I've spent a lot of time filling out medical paperwork.  And I can't even imagine how much more complicated this would be if I had kids! 

So I decided to create a document for my computer where I can easily access all of this information.  It has already been a huge timesaver, and I have it here for you to download and use as well! 


I'm planning to keep mine saved on my computer for easy editing.  However, I'm also including a printable version for you in case you like to keep paper copies.  Just print out as many of each page as you need.  The document includes: 

Page 1: Basic Information

For those of you with kids, I included this cover sheet so that you can create a different record for each child, and easily keep them straight.

Page 2: Current Providers

This is the spot to write basic contact information for doctors, dentists, insurance companies and pharmacies.  There are two extra spaces to include information for others, such as allergists or dermatologists.  

Page 3: Past Providers

If you've moved or switched doctors a lot, this page is for you! Keep a record of your recent past providers and the dates that you used their services. 

Page 4: Vaccination Records 
Your doctor will have a copy of this as well, but I've found it very handy to have my own record on hand.  You can easily look down your list and find the dates of each vaccination.  

Page 5: Medical Events This is a catch-all page for easy access to dates and details about important events in your medical history.  These might include surgeries, hospitalizations, and important doctor's visits or procedures.  You know- the things that you're always being asked about when you join a new doctor, and can never quite remember the dates on which they occurred... 

Page 6: Medications 

This is a place for you to record prescriptions or medications you've taken, along with dates.    

I recently had to fill out forms for (another) doctor, and I was amazed at how easy it was with my new records close at hand.  I hope this document saves you some time and trouble as well. Enjoy!  

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