St.

Joseph College
Institute of Health Sciences
Cavite City

HEALTH HISTORY
I. Biographic Data
Name:
Address:
Age:
Sex:
Occupation:
Religious Preference:
Health Care Financing:
Usual Source of Medical Care:
II. Chief Complaint or Reason for Visit

III. History of Present Illness

IV. Past History

V. Family History of Illness

VI. Lifestyle

VII. Social Data

VIII. Psychological Data

IX. Patterns of Health Care