Figure is a printed medical history form that Dr. Mike Robe, a family practitioner, has his receptionist give to all new patients. All patients must fill it out before they see the doctor. The receptionist is getting back many incomplete or confusing responses, which makes it difficult for Dr. Robe to review the forms and understand why the new patient is there. In addition, the poor responses make it time consuming for the receptionist to enter new patients into the files.

Redesign the form on 81/2” * 11” paper so that pertinent new patient data can be collected in a logical and inoffensive way. Make sure the form is self-explanatory to new patients. It should also be easy for Dr. Robe to read and easy for the receptionist to enter into the patient database, which is sorted by patient name and Social Security number. The office uses PCs connected by a LAN. How would you redesign the form so that it can be electronically submitted by the receptionist? Which office procedures would you have tochange?

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Medical History Form Employer Address Zip PhoneOffice Insurer Is this [ ] your policy [ ] your spouse's policy Blue Cross I State Physician's Service 1 Other (state) Have you ever had surgery? YesNo If so, when? Describe the surgery Have you ever been hospitalized? Yes_ No If so, when? Why? Complete the following I have had Family history Diabetes Heart trouble Cancer Seizure Fainting What have you been immunized for? Family: Date of last examWho referred you? Why are you seeing the doctor today? Are you currently having pain?Constant How long does it last? IMPORTANT! We need your correct insurance carrier number Spouse or next ofkin Relainship Addres Please give us your soc. sec. f