Child Medical History Form

Megan Jackson

Advance your healthcare facility with our new Child Medical History Form. Now available within our 140 pre-built app catalog. FREE with your subscription to Forms On Fire.

With Forms On Fire, you can manage your on-the-go workforce more effectively by capturing and recording the critical data your business uses. Our system is a searchable, reportable database that is instantly available from the web, smartphones or tablets. Streamline tasks like new patient intake, patient survey, child medical history and more. Our pre-built apps can be quickly changed using our simple drag n’ drop form designer.

Build your own forms or start with one of our pre-built forms. Not just forms but applications that will prove to delight! Manage all your entire medical office starting with our Child Medical History Form. Available on iOS and Android.

Information gathered in the Child Medical History Form includes:

Basic Information of Medical History
Child Name
Child Age
Gender
Child Mother Name
Contact Number
Address
Genetic Medical History
Date Completed
Child’s Name
Form Completed
Child’s Health History
Rubella (2 week)
Yes or No selection
Date picker
Comments section
Heart Murmur
Yes or No selection
Date picker
Comments section
Mumps
Yes or No selection
Date picker
Comments section
Hay Fever
Yes or No selection
Date picker
Comments section
Bladder Infection
Yes or No selection
Date picker
Comments section
Meningitis
Yes or No selection
Date picker
Comments section
Medical Information
Doctor’s Name
Degree
Contact Number
Signature

Forms On Fire integrates to over 500 systems out of the box. Store your Child Medical History Forms in Word, Excel, PDF or all three. Forms On Fire supports email, saving to DropBox, Google Drive, OneDrive and more. Easily organize your data and connect to your electronic medical records system. Supported connectors even include REST!

Other pre-built mobile form applications include:
New Patient Intake form
Doula intake form
Health evaluation form
Healthy haircare goals
Nursing assessment
Nursing services inquiry form
Patient demographic information
Patient satisfaction survey
Personal training consultation questionnaire

Forms On Fire is HIPAA compliant and meets the highest standards of security and reliability. Start a free trial of Forms On Fire and instantly install and begin using our Child Medical History Form.