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Medical History Form

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Healthcare Document Intelligence

The world's best medical history extraction

Digitize comprehensive patient medical histories with precision. Extract past diagnoses, surgical history, current medications, allergies, and family health patterns. Enable informed clinical decision-making with structured, searchable health data.

medical-history.pdf

Viewer

JSON

patient_name

Robert A. Martinez

patient_dob

1965-11-08

patient_gender

Male

medical_record_number

MRN-2024-34521

form_date

2024-03-15

chief_complaint

Annual physical examination

Past_medical_history

3 items

condition

icd10_code

diagnosis_year

status

Type 2 Diabetes Mellitus

E11.9

2015

Active

Essential Hypertension

I10

2012

Active

Hyperlipidemia

E78.5

2018

Active

Surgical_history

2 items

procedure

cpt_code

year

Appendectomy

44950

1998

Right knee arthroscopy

29881

2019

Current_medications

3 items

medication

dosage

frequency

Metformin

1000mg

Twice daily

Lisinopril

20mg

Once daily

Atorvastatin

40mg

Once daily at bedtime

Allergies

2 items

allergen

reaction

Penicillin

Hives and swelling

Sulfa drugs

Rash

Family_history

3 items

relation

condition

age_at_onset

Father

Myocardial infarction

Mother

Type 2 Diabetes

Brother

Hypertension

social_history

smoking_status: Former smoker, quit 2010, alcohol_use: Occasional, 2-3 drinks per week, exercise: Walks 30 minutes daily

reviewing_provider_name

Dr. Amanda Collins, MD

reviewing_provider_npi

1234567890

{ "patient_name": "Robert A. Martinez", "patient_dob": "1965-11-08", "patient_gender": "Male", "medical_record_number": "MRN-2024-34521", "form_date": "2024-03-15", "chief_complaint": "Annual physical examination", "past_medical_history": [ { "condition": "Type 2 Diabetes Mellitus", "icd10_code": "E11.9", "diagnosis_year": "2015", "status": "Active"}, { "condition": "Essential Hypertension", "icd10_code": "I10", "diagnosis_year": "2012", "status": "Active"}, { "condition": "Hyperlipidemia", "icd10_code": "E78.5", "diagnosis_year": "2018", "status": "Active"} ], "surgical_history": [ { "procedure": "Appendectomy", "cpt_code": "44950", "year": "1998"}, { "procedure": "Right knee arthroscopy", "cpt_code": "29881", "year": "2019"} ], "current_medications": [ { "medication": "Metformin", "dosage": "1000mg", "frequency": "Twice daily"}, { "medication": "Lisinopril", "dosage": "20mg", "frequency": "Once daily"}, { "medication": "Atorvastatin", "dosage": "40mg", "frequency": "Once daily at bedtime"} ], "allergies": [ { "allergen": "Penicillin", "reaction": "Hives and swelling"}, { "allergen": "Sulfa drugs", "reaction": "Rash"} ], "family_history": [ { "relation": "Father", "condition": "Myocardial infarction", "age_at_onset": 58 }, { "relation": "Mother", "condition": "Type 2 Diabetes", "age_at_onset": 52 }, { "relation": "Brother", "condition": "Hypertension", "age_at_onset": 45 } ], "social_history": { "smoking_status": "Former smoker, quit 2010", "alcohol_use": "Occasional, 2-3 drinks per week", "exercise": "Walks 30 minutes daily"}, "reviewing_provider_name": "Dr. Amanda Collins, MD", "reviewing_provider_npi": "1234567890"}

medical-history.pdf

Viewer

JSON

patient_name

Robert A. Martinez

patient_dob

1965-11-08

patient_gender

Male

medical_record_number

MRN-2024-34521

form_date

2024-03-15

chief_complaint

Annual physical examination

Past_medical_history

3 items

condition

icd10_code

diagnosis_year

status

Type 2 Diabetes Mellitus

E11.9

2015

Active

Essential Hypertension

I10

2012

Active

Hyperlipidemia

E78.5

2018

Active

Surgical_history

2 items

procedure

cpt_code

year

Appendectomy

44950

1998

Right knee arthroscopy

29881

2019

Current_medications

3 items

medication

dosage

frequency

Metformin

1000mg

Twice daily

Lisinopril

20mg

Once daily

Atorvastatin

40mg

Once daily at bedtime

Allergies

2 items

allergen

reaction

Penicillin

Hives and swelling

Sulfa drugs

Rash

Family_history

3 items

relation

condition

age_at_onset

Father

Myocardial infarction

Mother

Type 2 Diabetes

Brother

Hypertension

social_history

smoking_status: Former smoker, quit 2010, alcohol_use: Occasional, 2-3 drinks per week, exercise: Walks 30 minutes daily

reviewing_provider_name

Dr. Amanda Collins, MD

reviewing_provider_npi

1234567890

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