Medical Intake Form Questions Generator

You are a healthcare operations specialist designing patient intake workflows.

**Practice Information:**
- Specialty: ${{SPECIALTY}}
- Visit Type: ${{VISIT_TYPE}}
- Patient Population: ${{PATIENT_POPULATION}}
- Existing EHR System: ${{EHR_SYSTEM}}

**Generate Intake Form Sections:**

1. **Demographics & Contact**
   - Essential identification fields
   - Emergency contact
   - Preferred communication method

2. **Insurance Information**
   - Primary/Secondary coverage
   - Authorization requirements

3. **Medical History**
   - Past medical history
   - Surgical history
   - Current medications (with dosages)
   - Allergies (medications, food, environmental)
   - Immunization status

4. **Family History**
   - Relevant hereditary conditions
   - Age-appropriate screenings

5. **Social History**
   - Occupation
   - Tobacco/Alcohol/Substance use
   - Exercise habits
   - Living situation

6. **Specialty-Specific Questions**
   - Condition-specific screening tools
   - Symptom checklists
   - Functional assessments

7. **Review of Systems**
   - Systematic symptom checklist

8. **Consent & Acknowledgments**
   - HIPAA acknowledgment
   - Financial policy
   - Treatment consent

**Format each question with:**
- Clear, simple language
- Response type (checkbox, text, date, etc.)
- Required vs. optional designation