Adolescent Health Transition Project
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Health History Forms

The Health History Summary is a condensed version of a teen's health and medical history, current status, supports, etc. This form is available in the following languages:

How do I use it?
The Health History Summary can be completed by a teen and his/her parent(s) together. It is a tool woman filling out formfor the teen to learn more about his/her general health and specific special health need and/or disability, how to access information and how to talk about his/her condition with adult health care providers and others. It is also a tool to help parents be aware of what their teen knows about his/her condition and therefore what gaps in knowledge and experience must be learned before the teen transitions to adult health care, work and independence.

Young adults with special needs are often unsure about which health information of an often lengthy health history they need to share with a new health care provider. The PDF document Health History Summary form for teens and their parents distills the most important facts in the teenager’s medical record. In addition to the general health history, the information covered includes medications taken, names of providers, surgeries and other significant health events, as well as family health history.

Youths and their families who have used this health history summary needed about 30-45 minutes to complete the information. It can be completed by the teen and his/her parents together.  If completed yearly, teens learn more about their general health and specific special health need. It helps teens with special needs learn what is most important about their health and provides opportunities to ask parents and health providers for more information. 

Parents find they better understand how much their child knows about their condition and are guided in what to teach their teen. Teens learn how to access information and how to articulate their knowledge of their condition. In addition, the collaboration on the health history summary helps parents to deprogram themselves from filling out all the paperwork!

Our suggestions for successful use of the PDF document Health History Summary:

  1. Begin in early teen years to complete a summary at least annually
  2. Modify the health history summary whenever you experience a major health event or a change in medication type or dosage.
  3. Complete the form as a parent-child team, moving more responsibility to the teen  for completion whenever reasonable.
  4. Ask questions of your health care provider and research library and/or reliable web resources for any further information you might need.
  5. Take this form with you whenever you will be meeting with a new health provider.

PDF document = PDF file. To view and print PDF files, you must download Adobe Acrobat Reader. Get Adobe Reader



This project is housed at the Center on Human Development and Disability (CHDD) at the University of Washington
Box 357920, Seattle, WA 98195-7920 | 206.685.1350 | Fax: 206.598.7815
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