For Your Hospital Stay - UCSF Medical Center

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18 Health History Complete this form and refer to it when you are asked about your medical history. Place of birth Allergies Childhood diseases/operations Health problems as an adult Previous operations <strong>Hospital</strong>izations Blood transfusions Accidents Drug reactions Date
Medication List Please list below all prescription and non-prescription (“over-thecounter”) medications you are taking, including supplements, vitamins and herbal supplements and teas. DO NOT bring medications with you to the hospital unless your doctor instructs you to do so. Name Drug name Dose How often I take it Why I take it Drug name Dose How often I take it Why I take it Drug name Dose How often I take it Why I take it Drug name Dose How often I take it Why I take it 19
Page 1: For Your Hospital Stay PRE-ADMISSIO
Page 4 and 5: 2 Welcome About our hospital Direct
Page 6 and 7: Scheduling your admission 4 Your he
Page 8 and 9: Advance directives Your privacy and
Page 10 and 11: In-room telephones Cell phones and
Page 12 and 13: Spiritual Care Services Patient Rel
Page 14 and 15: 12 Prepare Clinic Surgical Patients
Page 16 and 17: 14 Discharge planning Home Health C
Page 18 and 19: Hugo St. 505 Parnassus Avenue, San
Page 22: 20 Appointment Card List informatio

For Your Hospital Stay - UCSF Medical Center

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