PERSONAL MEDICAL

HISTORY
DATE: __________________ DATE OF BIRTH: ________________
NAME: _________________________________________________
LAST NAME: ____________________________________________
PHOTOGRAPH
AGE: ___________________ SURGERIES: yes no

GENDER: male female

PHONE NUMBER: _________________________
ALLERGIES TO MEDICATIOS: yes no
if yes list allergies____________________________
ALLERGIES TO FOOD: yes no
if yes list allergies____________________________
DOCTOR: __________________________________
WEIGHT: _________
SIZE: ____________

DOCTOR VISIT CHECKLIST

DATE VISIT NUMBER REASON DOCTOR SIGNATURE

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 VISIT # 1: NERVOUS SYSTEM
CASE:
The patient was riding bike in the park and fell of his/her bike, he/she wasn´t wearing a
helmet and now he can´t remember his name and what happened.

SYMPTOMS:
Headache, loss of memory, blurry vision, vomit.
CAUSES:

________________________________________________________________________
POSSIBLE SOLUTIONS:
________________________________________________________________________
________________________________________________________________________

EXTRA KNOWLEDGE Connects the brain with the body

1 Central nervous system

2 Peripheral nervous system Control every action in the body
3 Brain
4 neurons Is formed by small nerves

nerve cells
Color the cerebrum with green color, the cerebellum with brown and the brain stem with yellow

2
 VISIT # 2: ENDOCRYNE SYSTEM

CASE:
The patient comes because in the last week he/ she has difficulties to sleep at night and
wake up early in the morning also after the physical exam the heart rate changes
frequently.

SYMPTOMS:
He/she fells sleepy, tired, vomit, headache and queasiness
CAUSES:

________________________________________________________________________
POSSIBLE SOLUTIONS:
________________________________________________________________________
________________________________________________________________________

EXTRA KNOWLEDGE

 the ____________________________control the amount of sugar in the blood.

 the____________________________control how the cells obtain the energy from
food.
 the____________________________ regulate the level of phosphorous and
calcium in the blood.
 the____________________________ tell to other endocrine glands what to do.
 the____________________________ regulate the immune system.
 the ____________________________ in male are in the testicles and in females in
ovaries.
 the____________________________help you sleep at night and wake up in the
morning.

3
 VISIT # 3: CIRCULATORY SYSTEM

CASE:
Patient comes with an urgency, he/she was in the job and felt a big chest pain, the patient
doesn´t have healthy habits, usually takes unhealthy food during the day and doesn´t
practice sports.
After a physical exam and different laboratory exams I observed the presence of fat in the
arteries.

SYMPTOMS:

He/she fells tired, chest pain, vomit, queasiness, difficulty to breathing,

abnormal heart beat

CAUSES:

________________________________________________________________________
POSSIBLE SOLUTIONS:
________________________________________________________________________
________________________________________________________________________

EXTRA KNOWLEDGE

4
5
 VISIT # 4: EXCRETORY SYSTEM

CASE: the patient was swimming in the sea yesterday and

the water was dirty because the contamination then
the patient spent the day in the beach and used the swimsuit
all day.
today when he/she went to the bathroom observed a
different color in the urine and felt an abdomen pain,
after a laboratory exam in the urine I observed a bacteria
that cause cystitis.
what is cystitis and what organ in the excretory system affects?
SYMPTOMS: urine with red color, abdomen pain, pain when urinates,
urinates with frequency
CAUSES:

_______________________________________________________________________
POSSIBLE SOLUTIONS:
_______________________________________________________________________
______________________________________________________________________

EXTRA KNOWLEDGE: circle and color the organs that contributes with the excretion

6
Complete and color the URINARY SYSTEM

7
 VISIT # 5: MUSCULAR AND SKEETAL SYSTEM

CASE: the patient was traveling to Cartagena by car and the car crashed with a
motorcycle, the patient fell off the car and hit his leg with a tree, now has great leg pain
SYMPTOMS: leg pain, swollen leg, immobilized leg

CAUSES:

_______________________________________________________________________
POSSIBLE SOLUTIONS:
_______________________________________________________________________
______________________________________________________________________

EXTRA KNOWLEDGE: what

type of muscles are affected
with the accident?
_________________________

8
 VISIT # 6: REPRODUCTIVE SYSTEM

MAN CASE: patient comes because he wants to be father and has an offspring with his
wife, but after 1 year his wife is not pregnant.
WOMEN CASE: patient comes because she wants to be mother and has an offspring
with her husband, but after 1 year she is not pregnant.
SYMPTOMS: he/she doesn´t have an offspring
CAUSES:

_______________________________________________________________________

POSSIBLE SOLUTIONS:
_______________________________________________________________________
______________________________________________________________________

EXTRA KNOWLEDGE: the human pregnancy spend 40 weeks label the

pictures. 40 weeks, 20 weeks, 32 weeks,16 weeks,24 weeks and 36 weeks

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 VISIT # 6: IMMUNE SYSTEM

CASE: the patient was traveling to Cartagena 2 weeks ago, she/he was in a familiar
party with 100 people, yesterday a laboratory exam arrives to his/her email and the
results where positive to covid-19, he/she is very scary because doesn´t have the
vaccine.

SYMPTOMS:
Fever, Dry cough, Fatigue, Aches and pains, Sore throat, Diarrhea, Conjunctivitis,
Headache, Loss of sense of smell or taste.
CAUSES:

_______________________________________________________________________

POSSIBLE SOLUTIONS:
_______________________________________________________________________
______________________________________________________________________

10
EXTRA KNOWLEDGE: how the covid-19 affects the different systems? remember the
teacher explanations.
NERVOUS SYSTEM:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
ENDOCRINE SYSTEM:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
CIRCULATORY SYSTEM:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
EXCRETORY SYSTEM:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
REPRODUCTIVE SYSTEM:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
MUSCULAR AND SYSTEM:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

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