Medical History intake Form
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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

Source: https://promptzyo.com/prompt/medical-history-intake-form