![]() |

DESCRIPTION
It is important to maintain a health and sickness history for yourself and for your children. This information can be available for future reference. Any health care provider you visit will ask about past medical experiences and about your health in general. Don't rely on memory. Write things down in a medical journal. It can be as simple as a spiral bound notebook or the information can be kept on a computer file or on specially designed health-history forms. The items listed below are suggestions for information that may be maintained in this personal medical record.
SOME ITEMS TO RECORD FOR YOU AND YOUR CHILDREN
Birth date and details about the delivery and birth and any problems encountered. Obtain copies of your and your children's medical records from your midwife or health care provider.
Serious illnesses and treatments.
Chronic illnesses and treatments.
Minor illnesses, problems or infections that recur such as ear infections, numerous colds, skin problems, headaches or others.
Medications prescribed and any side effects or adverse reactions to them. List the generic name as well as the brand name of each medication. If unsure, ask the pharmacist or your health care provider.
Information about non-prescription medications or supplements taken on a regular basis (vitamins, laxatives, aspirin) should be noted and any reaction to them and if they helped the problem being treated.
Alternative therapies used should also be included in your information. This may include herbal supplements, Reiki therapy, chiropractic care, naturopathy, homeopathic therapy, acupuncture, aromatherapy, and others. You should note any reaction to them and if they helped the problem being treated.
Allergies to food or environmental agents.
Immunizations, if any. Note any reactions and adverse effects.
Medical tests and results. This can include such items as weight, height and blood pressure when taken by your midwife or health care provider.
Operations and hospitalizations.
Keep a record of your exercise habits.
Note down any special weight-loss diets tried and their results.
Any significant weight changes that occur.
Note dates and results of any self-testing performed, such as breast exam or skin exam.
Sexual problems for both male and female partners. Sexual activity record for a non-monogamous sexually active person and whether protection was used.
Ongoing use of alcohol and amount consumed; cigarette smoking and number smoked.
Make a note of emotional disorders such as stress, depression, feelings of sadness or other problems that can affect emotional well-being.
Note sleeping patterns and difficulties. If you take any medications, supplements or use any therapies to help you with sleep, note these as well. If you have nightmares or other sleep-related problems, write down details, feelings and any other helpful information.
Reproductive history (date of first menstrual period, length of menstrual cycles, contraceptive methods used and pregnancy history).
Note down any other facts about health matters, no matter how minor, that you think may be useful to your health care provider or midwife.
Medical history of parents, brothers and sisters and grandparents that include any serious illnesses, or other medical, mental or emotional problems. Find out about cause of death for deceased family members. Especially important is information about asthma and allergies, breast cancer, diabetes mellitus, glaucoma, Alzheimer's disease, alcoholism and carriers of recessive genes related to inherited disorders.
Keep copies of prescriptions, test results and immunization records in the same file.
Take this medical record with you when a visit to a health care provider or midwife is scheduled. It will assist you in answering questions correctly and completely when a medical history is taken.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has questions or concerns about your medical history information.
MoonDragon's Client Registration Form - Health & Obstetric History
MoonDragon's MDBS Client Forms Index
![]()
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
![]()
Click Here To Visit Herbal Remedies Product Page
MoonDragon's Health Index Page
MoonDragon's ObGyn Information Index by Subject Order
MoonDragon's ObGyn Information Index by Alphabetical Order
MoonDragon's Main Indexlisting
MoonDragon's Home Page