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  • SI O Eunoqen: 0-t F''C L:?J

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    Imogene Belles
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    This health screening form contains information about a patient seen by an intern named Marikitte S. Ocampo. The patient is identified as Vegan Zoe, who is 40 years old. Their vital signs and medical history are documented, including a chief complaint of cough for 3 days and a past medical history notable for hypertension. A social history of working as a cashier and no smoking or drinking is provided. No current medications are listed.

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    PACUNAYEN_CHART

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    This health screening form contains information about a patient seen by an intern named Marikitte S. Ocampo. The patient is identified as Vegan Zoe, who is 40 years old. Their vital signs and medical history are documented, including a chief complaint of cough for 3 days and a past medical history notable for hypertension. A social history of working as a cashier and no smoking or drinking is provided. No current medications are listed.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    7 views1 page

    SI O Eunoqen: 0-t F''C L:?J

    Uploaded by

    Imogene Belles
    This health screening form contains information about a patient seen by an intern named Marikitte S. Ocampo. The patient is identified as Vegan Zoe, who is 40 years old. Their vital signs and medical history are documented, including a chief complaint of cough for 3 days and a past medical history notable for hypertension. A social history of working as a cashier and no smoking or drinking is provided. No current medications are listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    LYCEUM OF THE PHILIPPINES UNIVERSITY - MANILA [ ] Actual Patient [ ] For Return Demonstration

    SENIOR HIGH SCHOOL


    Health Science 3 Health Assessment and Basic Clinical Skills

    HEALTH SCREENING FORM

    Name of Intern: )IY\aq:ttie SI On c,h-G O~eunoqen Section: Date: ID f U: I A I

    Patientldentifier: \leGl)f\0 Zoe Q,elt<S Birthday: 0-t I O'J I ,i,-=, Age: ,t,C,

    Sex: _~Y.____ Height: f''C> c.m. Temperature: !<,• a c Pulse: __,..c..-0_ _ _ _ / min

    Weight: l:?J j} kg. Respiratory Rate: __I....:(,__ / min Blood Pressure: 12. o /11' mmHg

    Drug Allergy: ___,n.e~n...'-:-_____________ Food Allergy: ....:..l'\!!eZ>'.!.h!.:~!i<_----------

    Color Sense: I Normal y1'Color-blindness


    Vision : (R) 20 / ~rt, yW/glasses ) W/O glasses I l Contact Lens
    (LJ20, ,ro
    Family History: (Heart Disease) _ __,_/
    __ (Diabetes)_/
    _ __

    (Hypertension) _ _/ __ (Cancer) __/_ __

    (Other) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    Chief Complaint:
    Gh1 bAYf ccu,glr\ oaol :IQN.ili:li<
    History of Present Illness:
    "'~~""Q l'OO"\ ... q pG~ 90 0.90:t"i
    Past edlcal History:
    (0 IOIA!rlUn On .. °"A"'°""',., .,, "q 1,c O.. i ntO Ce 11cah I

    Social History:
    tJatolOS Of "~r uovk card1·:tioq or o t,vrfA In <e"i o1
    wCll'"c,\ •
    Medication History: -"nuO.u!'\Q..!I'(~_ _ _ _ _ _ _ _ _ _ _ _ _ _ [ I alcohol drinking [ I cigarette smoking
    Medication Route Frequency Last Dose (dale/time)

    I T .,.,.
    a. .In
    ''"' l
    \ I' Ir\
    I ,-
    l \
    l r;
    -
    ,-
    d
    I rI
    I I
    ' T I

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