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Magdagdag ng ibang detalye

Medical history Nais po ng aming mga doktor na matugunan ng matuwid at makabuluhan.ang inyong katanungan sa kalusugan. And pagsagot sa mga katanungan sa ibaba ay lubos na makakatulong sa pag-unawa ng inyong karamdaman. Asahan po ninyo na kayo lamang at mga doktor dito ang makakabasa ng nilalaman.

Age: *

Gender: *

Weight: *

Height: *

Family History: Mayroon ka bang kapamilya o kamag-anak na mayroong alin man sa mga sumusunod?

Astma (Hika)

Cancer:

Diabetes

Heart Disease

High blood pressure (Altapresyon)

Hypercholesterolemia

Kidney problems (Sakit sa bato)

Liver problems (Sakit sa atay)

Lung problems (Sakit sa baga)

Stroke

Tuberculosis

Thyroid problems

Others: (Isulat ang ibang sakit na wala sa itaas):

Allergy:

Do you smoke? (Naninigarilyo ka ba?) *

Do you drink? (Umiinom ka ba?) *

Isulat mga gamot na iniinum sa kasalukuyan:

For better answers from your doctors, we recommend you to answer the following questions honestly and accurately. Rest assured that only you and your doctors will see its contents.

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