Professional Documents
Culture Documents
Alleviating Factors
Aggravating Factors
Any changes in color? Any pain or enlargement? Any itching or rashes? History of scarring or diseases? Sores that will not heal? Allergies to environmental allergens or food? Any new medications?
Any headaches? Dizziness? Syncope? Head injuries? Loss or change in consciousness? Thyroid problems Swollen glands? Pain or stiffness of neck Any problems swallowing?
Visual acuity problems? Changes? Last eye exam? Pain ? Where? Hearing loss? Discharge or drainage? Vertigo? Tinnitus? Sense of Smell?
Frequent colds? Epistaxis? Postnasal drainage? Allergies? Recurrence of symptoms? Change in voice? Sore throat? Bleeding or Swelling of the gums?
Tooth abscesses or extractions? Swelling? Ulcers in mouth? Disturbance of taste? Last dental exam?
Respiratory System Any cough? Sputum production? Hemoptysis? Wheezing? History of asthma, bronchitis,emphysema?
Varicosities = varicose veins? Peripheral neuropathies? History of DVT? Swelling of feet, legs, hands Pressure, pain or heaviness in arms, jaw, or chest
Loss of consciousness? Speech difficulty? Change in processing information? Swallowing difficulty? Confusion?
Neurological
Weakness? New Falls? Dropping items weak grip? Change in balance, gait?
Dyspepsia? Diarrhea? Constipation? Nausea or vomitting? Allergies/ food intolerances? Abdominal pain?
Bloating? Excess flatus? Belching? Change in color of stools? Change in consistency of stools? Pain with eating or defecating?
History of kidney or bladder disease? Urinary frequency? Burning? Nocturia? Changes in urine color? Clarity or odor of urine?
Pain? Excessive thirst? Swelling of legs, hands, eyelids? Dietary intake of calcium? Chills or fever? inability to urinate?
Female history of pregnancy G: P: A: Onset of menses? Last menstrual cycle? Onset of menopause? Unusual bleeding? Impotence?
Prostate problems? Age when sexually active? Sexual partners? Any new ones? Pain with sex? Change in libido?
Fertility problems? Pain in breasts? Lumps? Pain or masses in testicles? Practices self-examination?
History of injuries or diseases? Back Pain? Limb or joint pain? Myalgias? Change in gait or balance? Neuropathies?
History of endocrine disorders? Excessive thirst, hunger, frequent urination? Cuts or sores that are slow to heal? Unexplained weight gain or loss? Changes in skin texture or color? Exopthalmos?
Thinning or brittleness of hair? Increase in facial or body hair? Fatique? Insomnia? Nervousness? Palpitations?
Growth normal for age? Changes in hair patterns? Change in menstrual patterns? Regular or irregular? Weight loss or gain? Cold or heat intolerances?
Any history of psychiatric problems? Marital status? Use of illicit drugs? Smoker? Alcohol? Ethnic/cultural background?
Psychosocial?
Occupation? If retired.from what profession? Educational level? Religious preference? Usual language? Health insurance? Difficulty sleeping, anxiety, depression, or fatigue?
Family/Marital problems Number of persons in household Income level/housing Health habits, exercise, gambling, etc..