Medical intake - One question at a time

New-patient intake for a family practice: demographics, insurance member ID, current medications and allergies. One question at a time with photos beside some questions and a trail of what you have answered.

About 6 min to complete. patient, intake, medical, insurance, conversational.

Questions in this template

1. Patient name
2. Date of birth
3. Sex recorded at birth
4. Phone
5. Email
6. Do you have health insurance?
7. Insurance company
8. What is your insurance member ID?
9. What brings you in today?
10. Do you take medicines regularly?
11. List each medication and dose
12. Have you ever been told you have...
13. Any drug allergies?
14. Which medicines and what happens?

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