Facesheet
The Facesheet is a snapshot of a patient's important information, including their personal details, contact info, medical history, and insurance. It's designed to help healthcare providers quickly view the most essential data during a visit, ensuring fast and efficient care.
Graphic 1:
Patient Report - Selected InformationThe following categories, when checked, will be included in the patient’s report:
- Primary Insurance: Details about the patient’s primary insurance provider.
- Secondary Insurance: Information on any secondary insurance coverage, if applicable.
- Allergies: List of known allergies that could affect treatment or medications.
- Patient Diagnosis: A record of the patient’s current medical diagnoses.
- Family History: Information on the medical conditions that run in the patient’s family.
- All Medications: A list of medications the patient is currently taking.
- Past Medical History: Details of any significant medical conditions or illnesses the patient has had.
- Past Surgical History: A record of surgeries the patient has undergone in the past.
- Social History: Information about the patient’s lifestyle, including smoking, alcohol use, or any relevant social factors.
- Vaccination History: A list of vaccines the patient has received.
- Patient Goals: The patient’s personal health goals, such as weight loss, improved fitness, or managing a condition.
Patient Demographics
- Full Name: The patient's complete legal name (e.g., Ali Basit).
- Gender: The patient's gender (e.g., Male, Female, Other).
- DOB: The patient’s date of birth (e.g., 05/01/2000).
- Marital Status: The patient’s marital status (e.g., Single, Married).
- Phone Number: The patient’s contact phone number.
- Email: The patient’s email address for communication.
- Full Address: The patient’s current home address for billing or contact purposes.
- Preferred Language: The language the patient prefers to communicate in.
- Religion: The patient’s religious affiliation, if relevant.
- Social Security: The patient's Social Security number (if required for insurance or identification purposes).
- Driver License: The patient’s driver’s license number, if applicable.
Emergency Contact Information
- Full Name: The name of the person to contact in case of an emergency.
- Phone: The phone number of the emergency contact.
- Relation: The relationship of the emergency contact to the patient (e.g., Mother, Father, Spouse).
