To give ESOL and literacy students forms they can complete in class or at
home for use during visits with health professionals.
When visiting the doctor, it seems that half the time is spent filling out forms.
The challenge of providing medical history is all the more daunting to ESOL
and literacy students, who must struggle with language or comprehension
challenges. However, that task can be made somewhat easier if they have handy
forms with their medical information to use during medical appointments.
The forms shown on pages 5 and 6 come from the newly released Virginia
Adult ESOL Health Literacy Toolkit, available at
The toolkit was designed by Kate Singleton, who is both
a social worker and adult educator. In this article’s sidebars, you can learn
more about the toolkit.
One of the forms shown in this issue focuses on a simple way that students
can report their medical history. The second form focuses on keeping track of
medication use, which is crucial information for preventing medication errors.
This activity would ideally be used during a focus on health in your lessons.
Some of the instructions below are from the toolkit. Both forms, “6.4 My
Medical History” and “6.5 My Medication List” can be found by clicking on
Links for Learners at
The Basic Activity
1. Tell students they will spend some time writing down their health
Discuss with the class why this is important.
2. Preteach any vocabulary on the forms with which your students may be
3. Provide copies of both forms, “My Medical History” and “My
Keep in mind that many students may not have
experience writing down this information before. Starting with the “My
Medical History” form, provide some examples under each subject area
of information students may want to include. You may want to have a
completed sample form ready to show to the class.
The Virginia Adult ESOL
Health Literacy Toolkit
a number of resources for
educators and students,
• reproducible lesson plans
• easy-to-read resources for
ESOL students on
using U.S. health care
• explanations of health
literacy terms, concepts,
• resources and tips to
access affordable care
Using Health Forms
Notebook • Winter 2014