February 18, 2008

ProfileMD will run on Palm Centro Smartphone

Our ProfileMD Classic personal health record functions properly on the new Palm Centro smartphone available in the USA through Sprint.

Centro Features
  • 320x320 pixel, 65K color screen
  • 64MB of storage memory
  • 1.3 megapixel camera
  • Removable battery
  • microSD memory card slot

Free Health Care Consumer Questionnaire Released

The FREE Health Care Consumer Questionnaire is a comprehensive medical history form designed to be filled out by the health care consumer prior to a visit with a health care provider.

This
MedicalTemplate is appropriate for a new patient evaluation or any visit to a health care provider.

The Health Care Consumer Questionnaire can also be used as a personal health record.

Read this document on Scribd: New Patient form

New Health Care Consumer Questionnaire Patient Name ________________________________ DOB ____/____/________ Date ____/____/________ In order to best serve your medical needs, we ask that you complete the following questionnaire as completely as possible. The Health Care Consumer (HCC) - Health Care Provider (HCP) relationship is a privileged relationship built on trust and honesty. By completing and signing this form, you acknowledge that you understand that any intentionally false information may seriously and adversely affect your health. Patient Name ___________________________________________________________________ Gender Last First Middle Date of Birth (MM/DD/YYYY) ‰M ‰F ______/______/__________ Social Security Number _____ - _____ - _______ If the person completing this form is not the patient, please write your name, your relationship to the patient, and why you are completing the form for this patient. Name__________________________Relationship________________Reason_____________________ Reason For Visit _____________________________________________________________________ Patient’s Personal Contact Information (Address and Phone) ____________________________________ ____________________________________ Emergency Contact (Address and Phone) Home Phone _____________________________ Work Phone _____________________________ ____________________________________ ____________________________________ Home Phone _____________________________ Work Phone _____________________________ Insurance Information (Insurance Company, Policy Number, Contact Number) ____________________________________ Policy#______________________________ Additional, or Secondary Insurance Company Contact # _____________________________ Fax (if known) _____________________________ ____________________________________ Policy#______________________________ Contact # _____________________________ Fax (if known)______________________________ Have you completed a Living Will OR designated a Durable Power of Attorney for Health Care? If yes, please provide a copy for your health care provider. Do you have any religious or cultural beliefs that may impact your health care? If yes, please describe ‰Yes ‰No ‰Yes ‰No ___________________________________________________________________________________ Methods of learning new material that I like best are: ‰Verbal Instruction ‰Written Instruction ‰Handouts ‰Visual (Pictures, Videos, etc) ‰You Do ‰You Do Not understand English well. The language you prefer _____________________ Level of education completed ‰<6th grade ‰6th – 8th grade ‰9th grade ‰12th grade ‰1-4 years college ‰>4 years college ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 1 New Health Care Consumer Questionnaire Patient Name ________________________________ DOB ____/____/________ Date ____/____/________ Names and Phone Numbers for Health Care Providers (HCPs) from whom you are currently receiving care (or have seen within the past 12 months), AND ANY Health Care Providers from whom you are obtaining prescriptions. _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ Contact #__________________________ Contact #__________________________ Contact #__________________________ Contact #__________________________ Contact #__________________________ Contact #__________________________ Please list all of the medications you are taking. Include over the counter medications, herbs & vitamins. Medication Name Dose Last taken Medication Name Dose Last taken ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Please list and describe allergic reactions you have had to food, medications or insect stings. Check if you are you allergic to ‰Shellfish ___________ ‰IV Contrast Dye __________ ‰Penicillins __________ Please list Food, Medication or Insect Allergies ___________________________________ ___________________________________ ___________________________________ ___________________________________ Reaction ___________________________________ ___________________________________ ___________________________________ ___________________________________ ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 2 New Health Care Consumer Questionnaire Patient Name ________________________________ DOB ____/____/________ Date ____/____/________ Please list your occupations. Include the length of time you performed in that role, and describe your work responsibilities in that occupation. (Include military experience.) Occupation ________________ ________________ ________________ ________________ ________________ Start Date ________ ________ ________ ________ ________ Stop Date _________ _________ _________ _________ _________ Responsibilities ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Have you ever been exposed to known cancer causing agents or inhalation hazards? ‰Yes ‰No Examples: asbestos, paints, aniline dyes, chemicals, silica, etc. If yes, please list types of exposure, time period exposed, and health problems experienced at time of exposure Agent ________________ ________________ ________________ Start Date ________ ________ ________ Stop Date _________ _________ _________ Health problems resulting from exposure ____________________________________________ ____________________________________________ ____________________________________________ Please describe your hobbies. _______________________________________ _______________________________________ _______________________________________ _______________________________________ Have you traveled, in the past 1 year? ‰Yes ‰No If so, please describe where, when, and for how long you were there. Travel destinations OUTSIDE the United States _______________________________________ _______________________________________ Travel destinations INSIDE the United States _______________________________________ _______________________________________ Dates spent at this destination _______________________________________ _______________________________________ Dates spent at this destination _______________________________________ _______________________________________ Do you exercise? ‰Yes ‰No If yes, describe how long and how often you exercise on average each week __________________________________________________________________________________ __________________________________________________________________________________ In the past 12 months, have you fallen? ‰Yes ‰No If yes, how many times? ______ If yes, have you ever broken bones, or sustained an injury, as a result of falling? ‰Yes ‰No ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 3 New Health Care Consumer Questionnaire Patient Name ________________________________ DOB Do you have a history of smoking? Have you ever chewed tobacco? Have you ever smoked pipes or cigars? Have you quit? If so, when. Have you considered quitting? Have you tried quitting? ____/____/________ Date ____/____/________ ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No If yes, ______ # packs per day X ______ for # years ‰No ‰No If yes, how many cigars or bowls _____ per ‰Day ‰Week ‰No __________________________________________ ‰No If yes, have you set a date to quit? ‰Yes ‰No ‰No If yes, what is the longest time period you quit smoking? ________ Do you have a history of alcohol use? ‰Yes ‰No If yes, specify _______ # drinks per ‰Day ‰Week 1 “drink” is equal to 12 oz. can of beer, 1.5 oz. liquor (80 proof) or 5 oz wine Have you ever experienced a blackout, or loss of consciousness due to alcohol intake? Have you ever needed to drink to prevent yourself from shaking, sweating, and becoming irritable? Have you ever been arrested or ticketed for DUI (Driving Under the Influence)? Have you been involved in any motor vehicle accidents in the past 12 months? ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No Do you use drugs for recreational purposes? ‰Yes ‰No If yes, check all that apply ‰Amphetamines ‰Cocaine ‰Marijuana ‰Heroin ‰Inhalants ‰LSD Method of delivery you chose ‰Ingestion ‰Injection ‰Inhalation How much would you use _________________________________________________________________ How long did you use drugs ______________________________________________________________ Have you quit? ‰Yes ‰No If so, when __________________________________________________ Have you ever taken drugs to prevent shaking, sweating and becoming irritable? ‰Yes ‰No Have you ever had a problem with addiction to prescription pain medication or benzodiazepines? ‰Yes ‰No If yes, specify when and which drugs. _____________________________________________ Are you sexually active? ‰Yes ‰No If so, do you practice birth control of any kind? ‰Yes ‰No If yes, check below all that apply ‰Condoms ‰Diaphragm ‰IUD (Intrauterine Device) ‰Birth Control Pills, Patches, Implants How many sexual partners have you had in the past 1 year? Have you ever had sex with a person who is the same gender as yourself, bisexual, or anyone who performs sexual favors in exchange for money or drugs? ‰Yes ‰No Have you EVER been diagnosed with a sexually transmitted disease (like syphilis, gonorrhea or HIV), or were you exposed to a sexually transmitted disease during childbirth? ‰Yes ‰No Do you have any tattoos or body piercings? ‰Yes ‰No Have you received any transfusions of blood or blood products? ‰Yes ‰No Describe your seatbelt use when you are driving, or a passenger in a vehicle ‰All the time ‰Most of the time ‰About half the time ‰Rarely ‰Never Do you keep firearms in your place of residence? ‰Yes ‰No If yes, are they kept in locked compartments, or do they have safety locks? ‰Yes ‰No Can you perform your own hygiene, dressing, cooking and shopping needs independently? ‰Yes ‰No Do you feel safe in your relationship? ‰Yes ‰No Have you ever been in a relationship where you were threatened, hurt or afraid? ‰Yes ‰No ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 4 New Health Care Consumer Questionnaire Patient Name ________________________________ DOB Have you ever had the following exams? If so describe when and why PAP Smear Prostate Biopsy Mammogram Colonoscopy ____/____/________ Date ____/____/________ ‰Yes ‰No ________________________________________________ ‰Yes ‰No ________________________________________________ ‰Yes ‰No ________________________________________________ ‰Yes ‰No _______________________________________________ EGD (Esophageal endoscopy) ‰Yes ‰No ________________________________________________ EKG Cardiac stress test ECHO Chest x-ray CT “CAT” scan of chest Pulmonary function test EEG Bone density test ‰Yes ‰No _______________________________________________ ‰Yes ‰No _______________________________________________ ‰Yes ‰No _______________________________________________ ‰Yes ‰No _______________________________________________ ‰Yes ‰No _______________________________________________ ‰Yes ‰No _______________________________________________ ‰Yes ‰No _______________________________________________ ‰Yes ‰No ________________________________________________ Have you had any of the following vaccinations? Check all that apply, and specify when last received. ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No ‰No ‰No Influenza Pneumonia Tetanus BCG Varicella HPV (Gardasil) __________________ __________________ __________________ __________________ __________________ __________________ If you are female, have you ever been pregnant? ‰Yes ‰No If yes, please describe Number of pregnancies? ______ Number of live births? ______ Number of miscarriages or abortions? _____ Age of onset of menstrual cycles? ______ Age of onset of menopause? ______ ‰NA Have you ever taken birth control pills, or used birth control patches or implants? ‰Yes ‰No If yes, what did you take and for how long? ___________________________ Have you ever been on hormone replacement therapy? ‰Yes ‰No If yes, what did you take and for how long? ___________________________ Did you ever have an IUD? ‰Yes ‰No If yes, was it removed? If yes, when __________ ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 5 New Health Care Consumer Questionnaire Patient Name ________________________________ DOB Past Medical History Please check all that apply. Adrenal Dysfunction Alzheimer Amyotrophic Lateral Sclerosis Anorexia or Bulimia Anxiety Disorder Arteriovenous Malformations (AVMs) Arthritis Asthma Autoimmune Disease Bipolar Disorder Bleeding Disorder Cataracts Cerebrovascular Accident (Stroke) Chemotherapy If yes, state when Claudication Clotting Disorder Congenital Heart Defects Coronary Artery Disease COPD Cystic Fibrosis Depression Diabetes Dialysis Eclampsia or Pre-eclampsia Endocarditis Endometriosis End Stage Renal Disease Erectile Dysfunction Esophageal Dysfunction Fibromyalgia Gallstones Gastritis or Gastric Ulcers GERD (reflux problems) Glaucoma Heart or Valve Defects Hemochromatosis Hemorrhoids Hepatitis HIV or AIDS Hypertension Hyperthyroidism Hypotension Hypothyroidism Inflammatory Bowel Disease ____/____/________ Date ____/____/________ ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No Irregular Heart Rhythm Kyphosis Liver Dysfunction Kidney Failure, or Dysfunction Malignancy If yes, describe below ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No Mania Muscular Dystrophy Myocardial Infarction (Heart Attack) Narcolepsy Obstructive Sleep Apnea Organ Transplant If yes, describe Osteoporosis Pancreatitis Periodic Limb Movement Disorder Peripheral Artery Disease Personality Disorder Pituitary Dysfunction Polycystic Ovarian Syndrome Pulmonary Artery Hypertension Pulmonary fibrosis Radiation Therapy If yes, explain Recurrent Infections Restless Leg Syndrome Sarcoidosis Schizophrenia Scleroderma Scoliosis Seizure Disorder Sickle Cell Sjogren Skin Disorders (Psoriasis, Acne) Thalassemia Thrombocytopenia Thrombophilia Transfusions Tuberculosis If yes, have you been treated? Urinary retention or urgency Vasculitis Visual defects Vocal cord dysfunction/paralysis ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 6 New Health Care Consumer Questionnaire Patient Name ________________________________ DOB ____/____/________ Date ____/____/________ Review of Systems In the last 6 months, have you experienced any of the following symptoms? Respond to each. Constitutional Weight Loss or Gain Appetite changes (increased or decreased) Fatigue, profound and impairs daily function Fever Shakes/sweats from lack of alcohol or drug ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No ‰No Genitourinary Blood in your urine Menstrual changes Urinating that is painful or difficult Erection problems Vaginal discharge or bleeding ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No Eyes Eye pain or drainage Visual changes Dry, irritated eyes ‰Yes ‰No ‰Yes ‰No ‰Yes ‰No ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ✔ ‰No ‰No ‰No ‰No ‰No ‰No Musculoskeletal Broken bones Joint pain or swelling Muscle aches Muscle weakness Back pain ENT/Mouth Ear pain or drainage Frequent sinus infections Hearing changes or loss Nosebleeds Dizziness Skin/Breasts Masses or lumps Nipple discharge Rashes or nonhealing ulcers ‰Yes ‰No ‰Yes ‰No ‰Yes ‰No ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰Yes ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No ‰No Respiratory Blood in your sputum Chest tightness Cough lasting >1 month, productive or not Shortness of breath Wheezing Chest pain with inhalation or coughing Neurologic Seizures Coughing or choking with swallowing Excessive daytime sleepiness Extremity pain or burning sensations Hallucinations Numbness or tingling Difficulty falling asleep, staying asleep Cardiovascular Chest pain or heaviness Palpitations Fainting or near fainting spells Swelling of feet or legs Shortness of breath lying flat in bed Endocrinologic Hair loss Frequent urination Increased thirst Heat or cold intolerance Gastrointestinal Abdominal pain Blood in your stool Constipation Diarrhea or Food Intolerance Heartburn or Indigestion Vomiting or nausea lasting for >1 day Swallowing difficulty Heme/Lymph Bleeding from gums or nose Unexplained bruising Night Sweats Swollen, painful lymph nodes Psych Anxiety without clear explanation Sadness lasting for days or weeks Hearing voices Thoughts of hurting yourself Thought of hurting others Fear of people, places or things Allergy/Immun Watery eyes Runny nose Food intolerance Frequent skin sores ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 7 New Health Care Consumer Questionnaire Patient Name ________________________________ DOB ____/____/________ Date ____/____/________ Please list all surgical procedures you have had. Please include surgeon and date of procedure. _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ Family Medical History Please list all known medical problems in your immediate family. (Specify M=Mother, F=Father, B=Brother, S=Sister, So=Son, D=Daughter, GM=Grandmother, GF=Grandfather) _________________ _________________ _________________ ______________________ ______________________ ______________________ ____________________ ____________________ ____________________ ___________________ ___________________ ___________________ Additional Information that you feel may be helpful for your health care provider to know. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Health Care Provider Notes __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ” MB & RR 2008 e-medtools.com ‰The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 8



The Health Care Consumer Questionnaire is a detailed 8-page snapshot of an individual’s current and past medical problems.

Information included in the Health Care Consumer Questionnaire

  • Allergies
  • Medications
  • Surgeries
  • Past Medical History
  • Family Medical History
  • Review of systems
  • Social History
  • Religious and cultural beliefs
  • Travel history
  • Occupational history
  • Carcinogen exposure history
  • Behavioral risk factors

February 17, 2008

OpenMedSpel for Mozilla Products released

OpenMedSpel is a open source USA English medical spelling word list that is released under a GPL license for Mozilla Firefox, Mozilla Thunderbird, and SeaMonkey.

Download OpenMedSpel for Mozilla Firefox
Install Instructions
Download OpenMedSpel for Mozilla Thunderbird
Install Instructions
Download OpenMedSpel for Seamonkey

February 15, 2008

GenericMedList Toolbar

GenericMedList now has a free search toolbar that can add GenericMedList to FireFox or Internet explorer. The GenericMedList Toolbar also includes our RSS news feeds and will notify users about updates to GenericMedList.



toolbar powered by Conduit


February 11, 2008

Add GenericMedList to search bar on Firefox and IE 7

GenericMedList custom search can be added to the Firefox 2.0 and Internet Explorer search bars.

To add GenericMedList search to your search bar, visit GenericMedList.com.

Select the search engine list, and add GenericMedList.


GenericMedList search will now appear in your search bar.

MedicalTemplate updates for 2/11/08

The latest MedicalTemplates that have been updated are:
The updated templates include a digital signature field and an improved layout.

February 8, 2008

MedicalTemplate Updates

The lung mass, pulmonary clinic initial evaluation, and primary care follow up MedicalTemplates have been updated with an improved format and quality reminders for the Medicare PQRI program.

February 7, 2008

GenericMedList offers iPhone optimized content

GenericMedList.com is now enhanced by the iWPhone WordPress Plugin to deliver content optimized for the screen size and Safari browser of the iPhone and iPod Touch.




February 3, 2008

Update for downloadable GenericMedList

The downloadable version of GenericMedList has been updated and can be downloaded from here.

This 4 page list details the generic drug discount programs at Walmart, Target, KMart, and Kroger stores. The free antibiotics programs at Meijer, Publix, and Schnucks stores is also included.

This one of a kind reference is a useful tool to anyone trying to select the most affordable medications.