DEPARTMENT OF PEDIATRICS

CCM MEDICAL COLLEGE, DURG

PATIENTS CASE SHEET

Name Age (with Date of Birth)

Sex Address of parents

Date of admission Informant

Reliability

PRESENTING COMPLAINTS

HISTORY OF PRESENT ILLNESS

PAST HISTORY

TREATMENT HISTORY

ANTENATAL HISTORY (H/O PREGNANCY)

FIREST TRIMESTER

SECOND TRIMESTER

THIRD TRIMESTER

NATAL HISTORY/BIRTH HISTORY (H/O DELIVERY)

POSTNATAL HISTORY

DEVELOPMENTAL HISTORY

GROSS MOTOR

FINE MOTOR

SOCIAL

LANGUAGE

NUTRITIONAL HISTORY/DIETARY HISTORY

IMMUNIZATION HISTORY

PERSONAL HISTORY (INCLUDING H/O ALLERGY)

FAMILY HISTORY

SOCIO-ECONOMIC HISTORY

ANTHROPOMETRY

WEIGHT EXPECTED WEIGHT

HEIGHT EXPECTED HEIGHT

HEAD CIRCUMFERENCE EXPECTED

MIDARM CIRCUMFERENCE (1-5 YEARS)

BODY MASS INDEX

WEIGHT FOR HEIGHT

WEIGHT FOR AGE

HEIGHT FOR AGE

UPPER /LOWER SEGMENT RATIO

VITALS

PULSE/HR BP

RR SPO2

TEMP
GENERAL EXAMINATION

GENERAL APPERANCE

COUNCIOUSNESS

PALLOR

ICTERUS

CYANOSIS

CLUBBING

EDEMA

LYMPHADENOPATHY

HEAD TO TOE EXAMINATION

HEAD

FACE

EYES

EARS

NOSE

ORAL CAVITY

NECK

CHEST /THORAX

SKIN, HAIR &NAILS

EXTREMITIES: BONES AND JOINTS

GENITALIAS
SYSTEMIC EXAMINATION

RESPIRATORY SYSTEM:

CARDIOVASCULAR SYSTEM:

PER ABDOMEN:

CENTRAL NERVOUS SYSTEM:

PROVISIONAL DIAGNOSIS

DIFFERENTIAL DIAGNOSIS