TCRC Pre-Admission Health History Form

Frequently when individuals with developmental disabilities are admitted to a hospital for any reason, the hospital staff have little general information about their patient. This lack of knowledge can lead to incorrect assumptions and mistakes in care. While it is critical that hospital staff have relevant information, it is equally important that they have specific information about an individual’s personal characteristics or preferences, such as communication styles and diet choices.

The goal of the attached Health History form is to provide an overview of the person and his/her individual needs. Please consider completing this document in advance of any possible referral to a hospital or other new health care provider, updating it at least annually, and keeping it handy with your records.  We hope this information will be useful in case of hospitalization or other unforeseen needs.

TCRC Health History Form