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  • Interviewing Patient Guide

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    Arnold Janssen Pascua
    13 views2 pages
    This document contains questions for a new patient intake form to gather biographical data, reason for seeking care, history of present health concern, past health history, and family health history. It asks for information such as name, address, date of birth, religious practices, education level, household members, health concerns, experiences with the organization, symptom details, past illnesses, surgeries, pregnancies, allergies, and family medical history.

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    patient interview guide

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    interviewing patient guide

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    This document contains questions for a new patient intake form to gather biographical data, reason for seeking care, history of present health concern, past health history, and family health history. It asks for information such as name, address, date of birth, religious practices, education level, household members, health concerns, experiences with the organization, symptom details, past illnesses, surgeries, pregnancies, allergies, and family medical history.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    13 views2 pages

    Interviewing Patient Guide

    Uploaded by

    Arnold Janssen Pascua
    This document contains questions for a new patient intake form to gather biographical data, reason for seeking care, history of present health concern, past health history, and family health history. It asks for information such as name, address, date of birth, religious practices, education level, household members, health concerns, experiences with the organization, symptom details, past illnesses, surgeries, pregnancies, allergies, and family medical history.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    BIOGRAPHICAL DATA

    Name
    Address
    Date and place of birth
    Religious or spiritual practices
    Educational Level
    Who lives with the client?
    Caregivers and support people from the client?

    REASON FOR SEEKING HEALTH CARE


    What is your health concern?

    Are you comfortable with seeking care from this organization? Past experiences good or not?

    HISTORY OF PRESENT HEALTH CONCERN


    Character of symptom or condition

    Onset (when did it begin; better? worse? same?)

    Location (where and does it radiate?)

    Severity (on a scale of 1-10?)

    Pattern (what makes it better? worse?)

    Associated factors (other associated symptoms? Effect on leisure or exercise?)

    PAST HEALTH HISTORY


    Problems at birth?

    Childhood illnesses?

    Immunizations to date?
    Acute or chronic adult illnesses (physical, emotional, mental)?

    Surgeries?

    Pregnancies? Births? Miscarriages? Abortions?

    Accidents? Injuries?

    Prolonged pain or pain patterns?

    Medications

    Allergies?

    FAMILY HEALTH HISTORY


    Recall as many genetic relatives as possible (parents,
    grandparents, siblings) with age, longevity, chronic illnesses
    (i.e., heart disease, stroke, diabetes, cancer, arthritis,
    Alzheimer's).

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