The Adult General Medical History form is a patient-completed questionnaire that captures a person's past conditions, surgeries, medications, allergies, and family and social history. Primary care practices and most specialties use it at intake to build an accurate clinical picture, guide the visit, and flag risks before the clinician walks in. This template is a starting point, so confirm wording with your own compliance team.
What does an Adult General Medical History include?
A general medical history collects the patient-reported information a clinician needs to assess current health and past events. Most adult intake histories cover these sections:
- Demographics and contact. Name, date of birth, address, phone, and preferred pharmacy so records and prescriptions route correctly.
- Chief complaint. The main reason for the visit and how long the concern has been present, in the patient's own words.
- Past medical history. Chronic conditions such as diabetes, hypertension, asthma, or heart disease, with dates or ongoing status.
- Surgical and hospitalization history. Prior operations, procedures, and inpatient stays, including approximate years.
- Current medications. Prescription drugs, over-the-counter products, vitamins, and supplements with doses where known.
- Allergies. Drug, food, and environmental allergies along with the type of reaction experienced.
- Family history. Conditions in close relatives, such as cancer, heart disease, or diabetes, that affect the patient's risk.
- Social history. Tobacco, alcohol, and substance use, occupation, and exercise habits that shape health and treatment.
- Review of systems. A checklist of current symptoms by body system that helps surface issues the patient may not mention.
How to administer the Adult General Medical History
- Send the form to the patient by text or email once the appointment is booked, so it is ready before the visit.
- Let the patient complete each section at home, where they can check medication bottles and confirm dates.
- Offer an in-clinic tablet for patients who did not finish ahead of time or who need help with the questions.
- Have front-desk staff review responses for blanks or conflicts and clarify anything unclear at check-in.
- Store the completed history securely in Zentake, where it stays encrypted and ready for the clinician to view.
- For returning patients, resend the form periodically so medications, allergies, and conditions stay current.
Who uses the Adult General Medical History?
- Primary care and family medicine. Used at new-patient intake and annual visits to establish a baseline health record.
- Specialty clinics. Cardiology, dermatology, and other specialties collect a general history before focused evaluation.
- Urgent care and walk-in clinics. Gather essential background quickly for patients the clinician has not seen before.
- Pre-procedure and surgical intake. Confirms medications and allergies that affect anesthesia and procedure safety.
Digital vs paper Adult General Medical History
| Paper | Zentake digital |
|---|---|
| Handwriting is often hard to read | Typed responses are clear and legible |
| Filled out in the waiting room | Completed at home before the visit |
| Signed with pen on paper | Signed electronically with a legal e-signature |
| Stored in physical files | Stored encrypted and HIPAA compliant |
| Retyped or rewritten for updates | Resent and updated in seconds |
| Staff enter and file each form by hand | Responses ready for staff to review instantly |
How Zentake helps with the Adult General Medical History
- Custom form builder. Adjust every section to your specialty with the custom form builder so you collect only what you need.
- Before the visit. Patients complete the history ahead of time, helping primary care practices start each appointment prepared.
- In-clinic tablets. Hand patients a tablet to finish the history on site when they arrive without it done.
- HIPAA compliant. Every response is encrypted, and a signed BAA is included on every plan.
References
The sections above reflect the standard components of a clinical history, including history of present illness, past medical, family, and social history, and review of systems, as described in the CMS Documentation Guidelines for Evaluation and Management Services and in primary care guidance from the American Academy of Family Physicians. This template is general and not legal advice; confirm required content with your own clinical and compliance teams.
Last updated: August 2026