Health History Questionnaire: 15 Must-Have Questions

Health History Questionnaire

What is a Health History Questionnaire?

A health history questionnaire consists of a set of survey questions that help either medical researcher, doctors or medical professional, hospitals or small clinics to understand the population they provide medical services to.

Using a questionnaire makes it easy to collect and analyze data for anything that can be as simple as college research or developing break-through medical developments. To treat a patient optimally a doctor must know the details of his/her medical history.

For example, some patients can be highly allergic to aspirin, which is a commonly used drug for treating cough and cold, mild fever, toothache etc. This should be known to the treating doctor. This information can be obtained from the patients or study subjects for clinical trials if they fill out a detailed questionnaire.

Here are some of the must-have questions in a health history questionnaire.

15 Must-Have Questions in a Health History Questionnaire

A. Demographic Questions

Demographic questions are an important aspect of a health history questionnaire. These questions are designed to help the researcher determine what factors might influence the respondent’s decision-making abilities. Collecting demographic information will help you cross-tabulate the information and compare it with other subgroups and see if responses vary between these groups.

  1. What is your age?
  • Under 18 years
  • 18-24 years
  • 25-34 years
  • 35-44 years
  • 45- 54 years
  • 55-64 years old
  • Above 64 years
  1. Please specify your ethnicity
  • White
  • Hispanic or Latino
  • Black or African-American
  • Native American or American Indian
  • Asian
  • Pacific Islander
  • Other
  1. Please select your highest level of education
  • No schooling completed
  • Some high school or diploma
  • High school graduate
  • Professional/Vocational/Technical Training
  • Bachelor’s degree
  • Master’s degree
  • Doctorate degree
  1. What is your marital status?
  • Single, never married
  • Married or domestic partnership
  • Widowed
  • Separated
  • Divorced
  1. Please specify your employment status
  • Unemployed but looking for work
  • Self-employed
  • Out of work but looking for work
  • A student
  • Homemaker
  • Military
  • Retired
  • Unable to work

B. Heath History Questions

  1. Have you ever been treated in an emergency room?
  • No
  • Yes, as a child
  • Yes, as an adult

Emergency rooms can be a place where there are memorable memories created or horrifying experiences gained, patients usually remember their ER experiences. As a researcher or a medical professional know why the patient(s) was there.

  1. Have you ever been rushed to the hospital in an ambulance? If Yes, do you remember why?

This is an open-ended question that will help an individual answer elaborately. Collecting important information is essential to understand if the individual has been through a certain experience and what were those like. Ride in an ambulance is during dire emergencies. If the individual has been through experience then it is essential to know why.

  1. Have you ever had an allergic reaction to…
  • Food
  • Drug
  • Insect
  • Substance

In the majority of cases, this question focuses more on the allergic reaction caused due to drugs. But it is important to know if a person is allergic to food products, certain types of insects or even substances like latex etc. Knowing allergic reaction have proved to save the lives of 17% Americans in 2018.

  1. Do you carry any medication in case of an emergency?
  • Nitroglycerine
  • Glucose
  • Insulin
  • Inhaler
  • Epi-Pen

This question is an important part of the health history questionnaire. This covers conditions that are or might be a part of a patient’s life that becomes an unconscious thought and they conveniently forget that they even have such a condition. For a patient to carry nitroglycerine for heart problem has become a habit. Only if they experience pain they are reminded of the condition they have.

  1. Do you wear any medical jewelry like a bracelet?

This is a question similar to the above question. However, this is also one of the important questions that should be asked without fail. There are a number of medical conditions that need a patient to wear medical jewelry to help others identify if they have an existing condition. The jewelry may be a part of the patient’s everyday life and he/she can get quite used to it.

  1. Have you ever received stitches?

The need for stitches can range from a variety of reasons, cuts that might have resulted during playing casually to accidents. It is important to know the answer to this question as the situation could also be an outpatient surgery.

  1. Have you taken tetanus in the last year?

Tetanus is an injection shot that you take when you step on a rusted nail or experience a cut from a rusted edge, dog bite etc. Information related to this can be helpful to identify past injuries or emergencies.

  1. Have you ever been admitted to the hospital?
  • Stroke
  • Childbirth
  • Accident
  • Tests
  • Observation
  • Psychiatric observation

Admission to the hospital for tests or general observation can be overlooked in comparison to childbirth and surgery. Some patients are not very comfortable sharing their mental health history unless they are questioned directly or more authoritatively. Information of this degree needs to be present on papers for a doctor to treat a patient fairly.

  1. Have you experienced a fracture or sprain?

If a patient has had a broken bone or few broken bones they usually tend to remember it. If the answer to this question is yes then ask them specifically which part of the body they broke a bone or two and how many times.

  1. Have you ever been denied medical insurance?

Permanent conditions, disabilities, pre-existing conditions are a few reasons why an individual can be denied medical insurance. These conditions can be identified with this question. Disqualification means the patient must be suffering from a condition and may be totally unaware of it and not even realized the reason for disqualification.

Tips to Write a Smart Health History Questionnaire

  1. Know your target audience: Know the people you want to gather information from. Ask only those questions that are absolutely essential. Asking vague questions can result in respondent leaving the absolutely essential questions as well, this is known as survey dropout. In conditions like these, you will not get the appropriate information you are looking for.
  2. Clearly define your questions: It is important that you ask clear questions. Consider using combinations of close-ended questions and open-ended questions. This way you will be able to gather maximum information from your respondents.
  3. Questionnaire length: Remember you are collecting vital information. Make sure your questionnaire is designed in such a manner that it doesn’t cause questionnaire boredom to your respondents. Again please don’t use medical jargons that might confuse your patients.
  4. Keep your records updated: Asking your patient the same everytime they visit you may get them irritated. Keep your records and data updated. Any questionnaire is deployed with the purpose of collecting first-hand information to make informed decisions. Please do not defeat this purpose.