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Table 2. Other Medical and Surgical History
Social History
• Race and ethnicity
• Gender identity and sexual orientation; pronouns
• Patient birthplace, residence, and travel history
• Employment history
• Incarceration history
• Education history
• Financial support
• Children: ages, plans for having children in the future; HIV status of children
• Pets
• Diet and exercise
• Sexual history: types of activity including partners and practices, sexual exposure sites,
STI prevention including condom use, past STIs, prior pre-exposure prophylaxis
(PrEP) use
• Marital/relationship status
▶ Partner(s) health and HIV status
▶ Partner(s) access to health care, including HIV testing (if appropriate)
▶ Disclosure of HIV status to partner(s)
• Social support and participation in support groups
• Disclosure history: friends, family, work colleagues
• Access to stable housing, food, transportation
• For minors, review legal guardianship and consent/assent
Medications
• Current medications, including over-the-counter medications, supplements
• Use of complementary or alternative therapy or treatment
Allergies and Intolerance
• Dates and types of reactions, including hypersensitivity reactions to ART
Healthcare Maintenance and Preventative Health Screenings (As Appropriate)
Dates of last:
• Mammogram
• Bone density
• Colonoscopy
• AAA screening
• Dental visit
• Dilated eye exam
(cont'd)
