2+MIST

Question 1

M–medications

Answer 1

1. Are you taking any medications? (Rx or OTC)

2. Are your immunizations current?

Question 2

I–injuries

Answer 2

1. Any significant injuries? (head,neck,spine,limbs)
2. Any fractures or dislocations?
3. Have you ever lost consciousness?

Question 3

S–surgeries

Answer 3

Have you had any surgeries? (wisdom teeth)

Question 4

T–transfusions

Answer 4

Any transfusions?

Question 5

Past Health Hx

Answer 5

Rate your overall health as poor, fair, good or excellent.
Any recent wt gain or loss?
Any concerns with your wt?

Question 6

Illnesses

Answer 6

Have you had sig illnesses as an infant child adult?

Do you have other current illnesses?