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Medical Information Worksheet

📝 A Simple Way to Stay Organized

 

I created this worksheet because many of my clients had their medical information scattered across different places—or were using forms that weren’t easy to read or fill out. This version is designed to be clear, convenient, and easy to use.

While it’s completely optional, filling it out ahead of your appointment can help us save time and ensure I have the most accurate information to support you. You can print it, fill it out digitally, or even email it to me before we meet.

📄 How to Save the Worksheet


On a Computer (Windows or Mac):

  1. Click the link to open the worksheet.

  2. Right-click anywhere on the page (or use the download icon).

  3. Select “Save As…” or “Download”.

  4. Choose a location on your computer (like your Desktop or Documents folder), then click Save.
     

On an iPhone or iPad:

  1. Tap the link to open the worksheet.

  2. Tap the Share icon (a square with an arrow pointing up).

  3. Tap “Save to Files” or “Save PDF to Books”.

  4. Choose a folder or location, then tap Save.
     

On an Android Phone or Tablet:

  1. Tap the link to open the worksheet.

  2. Tap the three dots in the top-right corner of your browser.

  3. Select “Download” or “Save as PDF”.

  4. The file will be saved to your Downloads folder.

☁️ Save It to the Cloud for Easy Access Anywhere

For added convenience, consider saving the worksheet to a cloud storage service like:

  • Google Drive

  • iCloud Drive

  • Dropbox

  • OneDrive
     

This way, you can access the worksheet from your phone, tablet, or computer—wherever you are. Just upload the file to your preferred cloud service after downloading it, and you’ll always have it handy for when you need the information.

Bonus Tip: You can also share this worksheet with your doctors to help them keep your medical records accurate and up to date. Here are a few easy ways to do that:

  • Bring a printed copy to your next appointment.

  • Upload it to your patient portal (if your provider offers one).

  • Email it to your doctor’s office—just be sure to use a secure method if possible.

  • Save it to your phone or tablet so you can access it quickly during visits

Alexander Efroymson wearing a suit

Alexander C Efroymson

Humana MarketPoint Sales Agent

CELL (239) 309-9267 (Call or Text)

EMAIL aefroymson@humana.com

ADDRESS 5237 Summerlin Commons Blvd, Fort Myers, FL  33907

FACEBOOK GulfCoastLocalAgent

PRODUCTS Medicare Advantage, Medicare Supplements, Medicare Prescriptions, Hospital Indemnity, Life Insurance, Long-Term Care, Annuities & Dental, Vision and Hearing plans.
LICENSES AL, FL, IN, KS, KY, LA, ME, MI, MO, NC, NY, PA, SC, TN, VA, WI

We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.

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