Orthopedics patient history sheet

Identifying data:
Name:___________________ Age:_____________________ Sex:_____________________

Occupation:_______________ Source of history:__________ Address:__________________

Presenting Complains:
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H/O Presenting Complains:

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Past History:
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Personal & Family History:

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 General Physical examination
Temp._____________ R/R_______________ Pulse______________ B.P_______________

Height_____________ Weight____________ Obesity____________ Anemia____________

Thyroid____________ Edema_____________ Jaundice___________ Nodes_____________

Systemic examination
Gastro-intestinal tract:
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Respiratory system:
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Cardio-vascular system:
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Central nervous system:

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Musculoskeletal system examination

Inspection:
Swelling__________________ Bruising__________________ Edema___________________

Palpation:
Joint warm_____________________________ Tenderness______________________________

Movement:
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Examination of radiograph:
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Diagnosis:
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Lab investigation:
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Treatment:
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Instruction to patient:
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