Medical History Information Forms

If you or a loved one needs to go to the hospital for any reason, make sure you’re prepared by gathering important medical information. Write down you and your family’s medical history, any medications that you are taking, and any allergies that you may have. Taking the time to do that now will help keep everyone safe in the future.

• Medical History Information Form (PDF) 

MyChart Account Users

Do you have a Yale New Haven Health MyChart account? Review your Health Summary information and add or edit information on file, including Current Health Issues, Medications, Allergies and Immunizations. You can print the entire summary by clicking the print icon on the top right corner of the MyChart page.