HEALTH - Medical History Form

Target Language or Knowledge:

The patient's name is Bob John Anderson. What is his first name?
Bob
The patient's name is Bob John Anderson. What is his last name?
Anderson
The patient's name is Bob John Anderson. What is his middle name?
John
The patient's name is Bob John Anderson. What is his middle initial?
J
apt. # = ______________________ ____________________
apartment number
prov. = _______________________
province
If you live in Saskatoon, your _________ ________ starts with S7.
postal code
Her date of birth (DOB) is March 7, 1990. How do you write it with only numbers in Canada? (month/day/year) [about the BABY in this photo]
03/07/90
"MI" means ___________ . ( i )
middle initial
"Do you have trouble sleeping?" means "Do you have ____ _____________ (with) sleeping?"
a problem
"Have you had surgery?" is about _______________.
any time in the past
"Signature" means you need to ________________.
write your name the way you write it for a bank
"Do you drink?" is about _____________ .
alcohol (ex. beer, wine)
"Are you on any medication?" means "___________?"
Do you take medicine every day?
about "height" - ___________
How tall are you?
about "weight" - _________
How much do you weigh?
"Are you taking any medicine now?" (medical history form) = _______
Do you take medicine every day?
"Do you have heart disease?" means "____________"
Do you have a heart problem?
Who is good to be your "emergency contact"? [BEST ANSWER]
a family member or friend who is 18 or older and lives in Saskatoon
You are a woman. You are married to a man. What is his relationship to you?
husband
You are a man. You are not married, but you live with a woman you love. What is her relationship to you?
partner or spouse
What does "explain" mean?
tell me more about it or tell me why