The following is a history and physical form approved by the Health Information Management Committee at the Hospital of Saint Raphael. In addition to meeting the Medical Staff Rules and Regulations related to the required elements of a history and physical (Article 4.2.3), it allows for communication between all care providers and provides a picture of the patient’s state of health, the list of medications and co-morbidities. This document is extremely helpful when planning the care of the patient and promotes safe and efficacious care. The form can be used by physicians, physician assistants, APRN’s and a physician’s designated staff person. Download the form.