Have patients conveniently fill out the medical history form via an online survey

Let your patients conveniently fill out the medical history questionnaire online. This saves you and your patients time and avoids unnecessary waiting.

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Why use a survey to collect medical history information?

A medical history questionnaire in the form of a survey is a modern, convenient, and efficient method for collecting patient data.

Instead of filling out the form in person, patients can conveniently complete the questionnaire from home — at a time that suits them best.

This digital process not only saves time for both parties but also reduces the stress that might arise from an in-person appointment.

The data is transferred directly into a system, eliminating the need for manual entry and minimizing errors.

In addition, the information is immediately available and can be processed quickly.

This speeds up the entire process and makes the work easier for practice staff.

Another advantage is that the patient can fill out the form at their own pace, without feeling rushed.

By integrating a medical history questionnaire as a survey, you not only improve efficiency but also enhance patient care by providing a seamless and user-friendly experience.

Contents of the template:

Request for contact information
Questions about lifestyle habits
Questions about current symptoms
Questions about medical history
Questions about occupation and social circumstances
Questions about vaccination status

Objectives of the survey:

Recording of medical history
Identification of risk factors
Preparation for treatment
Improved communication between patient and doctor
Legal protection through documentation of information

Helpful features for the survey:

Survey options: Anonymous, partially anonymous, personalized
Invitation options: Link, email, QR code, and more
Multilingual support, including automated translation
Automatic email notification after the form is submitted

Data protection „made in Germany“ (GDPR)

Anonymity function for honest feedback

Frequently asked questions about medical history?

What is a medical history?

A medical history, also known as anamnesis, is the systematic collection of a patient’s medical history by a doctor or other healthcare professional.

The purpose of taking a medical history is to gather relevant information that is important for the patient’s diagnosis, treatment, and care.

A medical history typically includes the following aspects:

1. Current complaints:

Symptoms and their onset, progression, intensity, and accompanying circumstances.

2. Previous medical conditions:

Information about previous illnesses, surgeries, hospital stays, or chronic conditions.

3. Medications:

Use of medications, both current and past.

4. Allergies and intolerances:

Reactions to medications, foods, or other substances.

5. Family medical history:

Illnesses and health problems within the family that may indicate a genetic or familial predisposition.

6. Social history:

The patient’s living circumstances, such as occupation, housing situation, and family circumstances, as well as habits such as smoking, alcohol, or drug use.

7. Mental health history:

Mental health, stress factors, emotional strain, and mental health conditions.

What is a biographical history?

A biographical medical history is a specific part of the medical history that examines a patient’s life story in depth.

It considers not only medical and physical aspects, but also the patient’s social, psychological, and personal experiences.

The goal is to gain a comprehensive picture of the patient that goes beyond their medical history alone.

A biographical medical history may include the following aspects:

1. Childhood and adolescence:

Important events, family relationships, school experiences, and formative experiences during early life.

2. Professional career:

Education, professional activities, career path, working conditions, and changes in working life.

3. Social relationships:

Partnerships, marriage, children, friendships, and other significant social contacts.

4. Cultural and religious influences:

Influences of culture, religion, and personal beliefs that have shaped the patient’s life and decisions.

5. Life crises and turning points:

Particular challenges, such as the loss of a loved one, serious illnesses, or other traumatic events.

6. Interests and hobbies:

Leisure activities, interests, and passions that form an important part of the patient’s life.

7. Life satisfaction:

Reflection on satisfaction with one’s own life, the importance of happiness and success, and an overall assessment of life.

What are the different types of medical history?

There are different types of medical history, which are used depending on the context and purpose of the assessment.

Here are the most important types of medical history:

1. Type: Self-reported medical history

The patient provides information about their symptoms, medical history, and other relevant details.

This is the most common type of medical history.

2. Type: Third-party medical history

Information is obtained from a third party, such as relatives, caregivers, or nursing staff.

This type is used when the patient is unable to provide information themselves, for example due to unconsciousness, cognitive impairment, or in the case of children.

3. Type: Special forms of medical history

Systematic medical history: Structured according to specific medical specialties or organ systems. Examples include cardiac history for the cardiovascular system, gynecological history, or neurological history for the nervous system.
Psychosocial history: Focuses on the patient’s social environment, work situation, psychological stress, and relationships.
Vegetative history: Relates to involuntary bodily functions such as sleep, appetite, digestion, sweating, and sexual function.
Medication history: Records current and past medication use, including dosage, duration of use, and any side effects.
Allergy history: Assesses possible allergies or intolerances to medications, foods, pollen, or other substances.
Family medical history: Examines illnesses and health risks within the family to identify genetic or hereditary conditions.

4. Type: Biographical medical history

This goes beyond medical and physical symptoms and records the patient’s life story, including social, psychological, and cultural aspects.

5. Type: Emergency medical history

A shortened form of medical history used in acute emergency situations.

In this case, the doctor focuses on the most important and urgent information, such as current symptoms, known allergies, pre-existing conditions, and medication use.

6. Type: Social history

Focuses on the patient’s social circumstances, such as housing situation, occupation, financial situation, family support, and potential social problems.

These different types of medical history help doctors and healthcare professionals gain a comprehensive picture of the patient’s condition and plan the best possible treatment.

What is the process for taking a medical history using an online questionnaire?

The process of taking a medical history using an online questionnaire differs in some respects from a traditional in-person medical history.

However, such a questionnaire can be an efficient way to collect important information from the patient in advance.

Here is a typical process:

Step 1: Access to the questionnaire

Invitation: The patient receives an invitation by email or through a patient portal to complete the online questionnaire.
Login: The patient logs in using a secure access code or a personal account.

Step 2: Introduction and explanation

Welcome: The questionnaire begins with a brief welcome message and an explanation of its purpose. It explains how the information will be used and approximately how long it will take to complete.
Data protection information: Information is provided about the security and protection of the patient’s personal data.

Step 3: Collect basic data

Personal information: The patient enters basic personal data, such as name, date of birth, gender, and contact information.
Insurance information: If relevant, health insurance information can also be requested.

Step 4: Current complaints (symptoms)

Main complaint: The patient selects symptoms from a list or enters their current complaints in an open text field.
Symptom details: More detailed questions about the onset, duration, intensity, and triggers of the symptoms.

Step 5: Pre-existing conditions and medical history

Chronic conditions: The patient provides information about existing chronic conditions.
Previous surgeries and hospital stays: Questions about past medical procedures and treatments.

Step 6: Medication history

Medications: The patient enters their current medications, including dosage and frequency of use.
Allergies: The questionnaire asks about known allergies or intolerances to medications and other substances.

Step 7: Family medical history

Hereditary conditions: The patient answers questions about illnesses that occur frequently within the family.

Step 8: Lifestyle habits and social history

Diet and exercise: Questions about the patient’s eating habits and physical activity.
Use of addictive substances: Questions about alcohol, tobacco, and drug use.
Professional and social situation: The patient provides information about their occupation and living circumstances.

Step 9: Vegetative and psychosocial medical history

Bodily functions: Questions about appetite, sleep, digestion, and other autonomic functions.
Mental well-being: The questionnaire includes questions about mood, stress, and general mental health.

Step 10: Summary and review

Review entries: At the end of the questionnaire, the patient has the opportunity to review and confirm their responses.
Open text field for additional information: A field for comments in which the patient can provide additional information that was not requested in the questionnaire.

Step 11: Submission and storage

Submit: The patient submits the questionnaire after answering all questions.
Automatic storage: The data is securely stored in the electronic health record and is accessible to healthcare professionals.

Step 12: Next steps

Doctor notification: The treating doctor receives a notification that the medical history questionnaire has been completed.
Analysis and preparation: The doctor can review the responses before the next consultation and prepare further questions if necessary.

Step 13: Follow-up consultation

Discuss the results: During the following consultation, whether online or in person, the questionnaire responses are discussed together and the doctor can ask targeted follow-up questions to clarify further details.
Further diagnostic process: Based on the medical history information, further diagnostic steps can be planned.

What kinds of questions are appropriate for a medical history form?

Here is a list of questions that can be used when taking a medical history.

These questions cover various aspects of a person’s health status and help build a comprehensive picture of the patient.

1. General questions

What is your name and date of birth?
What is your occupation, and what does your typical workday look like?
Do you have family members who suffer from similar symptoms?

2. Main complaint

What brings you here today?
How long have you had these symptoms?
Have the symptoms changed since they first appeared?
Are you experiencing pain? If so, where exactly, and how would you describe it—for example, sharp, dull, or burning?
Is there anything that worsens or relieves the symptoms?

3. Pre-existing conditions

Do you have any known chronic conditions, such as diabetes, high blood pressure, or asthma?
Have you had any serious illnesses in the past? If so, which ones and when?
Have you ever had surgery? If so, what type and when?
Have you had any accidents or injuries in the past that may be relevant?

4. Medication history

Do you take medication regularly? If so, which medication and at what dosage?
Have you taken any medication in the past that may be relevant to your current symptoms?
Have you ever experienced side effects from medication?
Do you use over-the-counter medication, vitamins, or dietary supplements?

5. Allergies

Do you have any known allergies, for example to medication, food, or pollen?
How do these allergies present themselves, for example through a rash, shortness of breath, or swelling?

6. Family medical history

Are there any known conditions in your family, such as heart disease, diabetes, cancer, or mental health conditions?
Are there any known genetic conditions in your family?

7. Social history

Do you smoke? If so, how many cigarettes per day and for how long?
Do you drink alcohol? If so, how much and how often?
Do you exercise regularly? If so, what type of exercise and how often?
How would you describe your diet, for example balanced, high in fat, or high in sugar?
Do you experience stress at work or in your private life? How do you cope with it?

8. Vegetative history

Have you noticed changes in your sleep patterns, such as sleep disturbances or lack of sleep?
Has your appetite changed? Have you lost or gained weight?
Have there been any changes in bowel movements or urination, such as frequency, consistency, or pain?

9. Mental health history

How would you describe your general mood? Do you often feel low or anxious?
Do you have problems with memory or concentration?
How capable do you feel of coping with the demands of everyday life?

10. Gynecological history (if applicable)

When was your last menstrual period? Is your cycle regular?
Do you have children? Were there any problems during pregnancy or childbirth?
Do you have any gynecological symptoms?

11. Geriatric history (for older patients)

Have you had mobility problems or falls recently?
Are you able to manage everyday activities independently?
Are there any difficulties with memory or signs of dementia?

12. Relevant previous examinations

Have you undergone any examinations recently, such as blood tests, X-rays, or MRI scans?
What diagnoses have been made in the past?

What role does data protection play in the context of taking a medical history?

Data protection when collecting medical history data is an extremely important consideration, as this involves highly sensitive and personal information.

Here are the key points that must be considered regarding data protection in connection with medical history:

1. Point: Legal basis and consent

Patient consent: Before medical history data is collected, the patient must explicitly give their consent. This can be provided in writing, electronically, or verbally. Consent must be freely given and informed, meaning the patient must know exactly which data is being collected and for what purpose.

Legal basis: The collection and processing of medical history data must be based on a legal basis, such as the General Data Protection Regulation (GDPR) in the EU, Germany’s Federal Data Protection Act (BDSG), or other relevant national laws.

2. Point: Data minimization and purpose limitation

Data minimization: Only data that is absolutely necessary for the respective medical treatment should be collected. Unnecessary data or data not related to the intended purpose must not be collected.

Purpose limitation: Medical history data may only be used for the purpose for which it was collected, such as diagnosing and treating the patient.

3. Point: Data security

Technical and organizational measures: Medical history data must be protected through suitable technical measures, such as encryption, and organizational measures, such as access controls. This applies both to data storage and transmission, for example when using online questionnaires.

Access restrictions: Only authorized healthcare professionals should have access to medical history data. It must be ensured that this data is not accessible to unauthorized third parties.

4. Point: Transparency and right of access

Patient information: Patients must be informed transparently about which data is collected, how it is processed, who has access to it, and how long it will be stored.

Right of access: Patients have the right to obtain information about their stored data at any time. They may also request that inaccurate data be corrected or unlawfully processed data be deleted.

5. Point: Retention periods and data deletion

Retention periods: Medical history data may only be retained for as long as necessary for the purpose of treatment or as required by law. Once these periods expire, the data must be securely deleted or anonymized.

Deletion policies: Clear policies should be in place for deleting or anonymizing data once the retention period has expired.

6. Point: Data sharing

Sharing only with consent: Medical history data may only be disclosed to third parties, such as other doctors, laboratories, or insurers, with the patient’s explicit consent, unless there is a legal obligation to do so.

Anonymization: Where possible, data should be shared in anonymized form so that the patient can no longer be identified.

7. Point: Use of online questionnaires

Secure access: Online medical history questionnaires should be provided through secure, encrypted connections, such as HTTPS.

Trustworthy platforms: It should be ensured that platforms used for online questionnaires comply with applicable data protection provisions and are provided by trustworthy suppliers.

Data storage: Responses should be stored securely, and patients should be informed where and for how long their data will be stored.

8. Point: Data protection officer

Larger medical institutions or practices should appoint a data protection officer who is responsible for compliance with data protection regulations and serves as a contact person for patients regarding data protection matters.

9. Point: Training and awareness

Healthcare professionals should receive regular data protection training to ensure that all data protection requirements are met and the importance of data protection is understood.