Creating a Medical History
Create a medical history
Store on a password protected thumb drive
Include the following format
Name/Birthdate ______________________________________________________
Relevant Medical History
Surgeries and Medical Events by decades/years
1940
1950
1960
1970
1980
1990
2000
2010
The above should include childhood illnesses, accidents, organ problems, etc.
Myeloma Diagnosis and treatment by date
Date of diagnosis
Treatment plan- Name of drugs, length of treatment, date of relapse/ or changes.
Kind of stem cell transplant if received? (Autologous or Allogeneic) and associated chemo/drugs, name of hospital.
Maintenance drugs?
Blood or platelet transfusions?
Kind of remission (Complete response, partial response or no response)
Date of relapse
Bisphosphonates schedule if any
Myeloma related medical events
Shingles /Herpes Zoster?
Problems with heart, lungs, kidneys, or other major body organs
Port infections?
Bone fractures or lesions
Other cancers?
Other events?
All current medications with dosage level and schedules
Allergies
Relevant Family History
Paternal
Maternal
Siblings
Contact information for all relevant doctors Names, phone numbers, hospitals,
etc.
You may need this information if you visit an emergency room in your hometown
or elsewhere. An ER doctor may prefer consulting with your physician before
treating you. Moreover, you will want all records of your ER visit sent to
your oncologist. Include name, clinic address and phone numbers or email addresses.
Templates
Template download for Microsoft Word
Template download for Corel Wordperfect
Plain text template