Paediatric History Taking

General Data

- (Name) unsa ang pangalan sa patiente? _______________________________________________

- Surname = apilido

- (Age) pila ang edad sa patiente? _______________________________________________

- Years = anyos - Year = tuig

- DOB _______________________________________________

- (Address) asa inyong gipuyan? _______________________________________________

- (Where are you from) taga asa man mo? _______________________________________________

- (How are you related to pt?) tig unsa nimo ang patiente?_________________________________

- (Blood group) dugo _______________________________________________

- (Religion) unsay inyong relihiyon? _______________________________________________

- (DOA)(when) kanusa siya na admit? _______________________________________________

- (How many days) pila na siya ka adlow diri? __________________________________________

Chief complaint and parts of HPI

- (problem) unsa ang problema niya? _______________________________________________

- (Duration) unsa kadugay na siya ingnon ani? ___________________________________________

- (Why are you here?) nganong ania ka? ______________________________________________

- (When) kanusa siya nag sakit? ______________________________________________

- (Assoc sx) na’ay uban na sakit? ______________________________________________

- (Status) kumusta na ang pte? ______________________________________________

Family history

Name Age (Job) unsa ang trabaho...

Father .. sa papa?

Mother .. sa mama?

Sibling 1

Sibling 2

- (Number of siblings)pila ang igsuon sa pte?_____________________________________________

- (Are the parents married) ______________________________________________

- If no, are they living together? ______________________________________________

- (Chronic Illnesses) naay kagihan na sakit sa mga kaliwat?

Father

Mother

Sibling 1

Sibling 2

Past history

- (Previous illnesses) naa ba siyay uban nasakit sa una?

Measles

Mumps

Chickenpox

Others/Allergies

- (Surgeries) gi-operahan na ba siya? ______________________________________________

- (Circumcision) gi-tuli na ba siya? ______________________________________________

- Prenatal:

- (Wt) pila sa timbang sa pte? ______________________________________________

- Medications taken during pregnancy ______________________________________________

- 1st prenatal check-up ______________________________________________

- (Febrile illness) hilanat? ______________________________________________

- (Smoking) sigarilyo Yes/No. If yes, pila? ________ alcohol? ___________

- (Bleeding) nag-dugo? ______________________________________________

- Hospitalisation ______________________________________________

- Lab procedures ______________________________________________

- Anemia, HPN ______________________________________________

- Prenatal visits ______________________________________________

- OB Score: G[ ] P[ ] F[ ] P[ ] A[ ] L[ ]

- (Age at pregnancy) pila inyong edad __ pregnancy ____________________________________

- Natal:

 - Gravida(No of pregnancy) kapila na siya nanganak? ___________________________________

- Paragravida(No of livebirths) pila nga anak nabuhi?____________________________________

- Birth rank: ______________________________________________

- Type of delivery: gi-cesarean o gi-panganak? ________________________________________

- If CS, ask for indication: ___________________________________________________________

- Presentation:

- (Head) ulo : [ ] - (Face) nawong : [ ]

- (Bottom) lubot : [ ] - (Chin) sawang : [ ]

- (Skull) bagolx2 : [ ]

- (Place of birth) asa nagpaanak sa bata?

- (Home) balay : [ ] - (Hospital) ospital : [ ]

- (Who delivered) kinsay nagpaanak sa bata?

- Midwife : [ ] - Doctor : [ ]

- (Duration of labor) unsa kadugay?

- (Premature) Sayo : [ ]

- - (Prolonged) nadugay : [ ]

- Normal : [ ]

- Postnatal:

- (Crying) nag-hilak na siya? [ ]

- (Jaundice) nag-dilaw na siya? [ ]

- (Cyanosis) nag-luspad na siya? [ ]

- Nutrition:

- (Cleft lip) bungi : [ ]

- How does mother feed?

- (On lap) gi-sabak [ ] - Ground: [ ]

- Wt gain:

- (Increased) timbang ani dako [ ]

- (Decreased) o ni-gamay [ ]

- (Sleep after feeding) pila ko oras? ______________________________________________

 - Normal: 1-2 hours

- (Urination and detection of bowel) Lima-sayis _________________________________________

- (Vitamin supplements) bitamina [ ]

- Type of formula:

- (Oz of H2O) pila ka onsa sa tubig? _______________________________________________

- (Giving) unsa ang pav hatag? _______________________________________________

- (Sterilisation) _______________________________________________

- (Weaning) nalutas na ba ang bata? _______________________________________________

- (Diet) unsay iyang pagkaon? _______________________________________________

- (Like/dislike) _______________________________________________

unsay iyang gusto i-kaon? _______________________________________________

- (Favourites) paborito _______________________________________________

- (Bottle feeding) gipa-totoy siya sa botelya?________________________________________

- Why? ngano _______________________________________________

Social history

- Property

- (Own) kamo ang tag-iya sa balay? [ ]

- (Rent) o nag-a bang mu sa balay? [ ]

- Residents in house

- Pila ka-buok nga tao nagapyo sa balay? _________________________________________

- Crown index: Number of members/Number of rooms _________________________________________

- (Source of Water) asa mu tig kuna ug tubig?

- (Sewage) kanal [ ]

- (River) suba [ ]

- (Well) atabay [ ]

- Tank [ ]

- (Pets) alaga

- (Dogs) ino : [ ]

 - (Cat) iring : [ ]

- (Goat) kanding : [ ]

- (Pig) baboy : [ ]

- (Cow) baka : [ ]

- (Chicken) manok : [ ]

Who : kinsa

What : unsa

Why : ngano

How : giunsa/naunsa

What : alang sa unsa

When : (past) kanusa/(future) anusa

What for : alang sa unsa

How did it happen? : naunsa pagkahitabo

S.Mc