The Prompt
Create a comprehensive medical history intake form for a [specialty] practice. Patient population: [describe] Practice type: [primary care/specialist/urgent care] Form sections: 1. Personal information 2. Chief complaint today 3. Current medications (name, dose, frequency) 4. Known allergies and reactions 5. Past medical history 6. Past surgical history 7. Family medical history 8. Social history (smoking, alcohol, exercise) 9. Review of systems by body system 10. Women's health (if applicable) 11. Mental health screening 12. Insurance and emergency contact Format as professional medical form Use clear yes/no checkboxes where appropriate Length: Comprehensive intake document
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How to Use This Prompt
- Click Copy Prompt above
- Open ChatGPT or Claude
- Paste the prompt and replace anything in [brackets] with your own details
- Press Enter and get your result instantly
Pro Tip
The more specific you are when replacing the [brackets], the better your result. For example instead of writing [Job Title] write "Senior Software Engineer with 5 years experience" — specificity is what separates a good AI response from a great one.
This prompt works best with ChatGPT . If you are not happy with the first result, try adding "make it more concise" or "give me 3 alternative versions" as a follow-up message.