18 HPI

Question 1

When did it start?

Answer 1

When did it start?

Question 2

Did it begin gradually or suddenly?

a. If gradually, over what period of time? How long to develop?

Answer 2

Did it begin gradually or suddenly?

a. If gradually, over what period of time? How long to develop?

Question 3

Did anything cause or contribute to the onset?

Answer 3

Did anything cause or contribute to the onset?

Question 4

Have you overhead anything like this before?

a. If yes, did it feel the same as this time? What was the outcome?

Answer 4

Have you overhead anything like this before?

a. If yes, did it feel the same as this time? What was the outcome?

Question 5

Can you point to the exact location of your symptom(s)? Describe.

Answer 5

Can you point to the exact location of your symptom(s)? Describe.

Question 6

Does it travel (radiate) to any other part of your body? Describe.

Answer 6

Does it travel (radiate) to any other part of your body? Describe.

Question 7

Do you have symptoms in any other part of your body?

Answer 7

Do you have symptoms in any other part of your body?

Question 8

Can you describe the sensation?(dull, sharp, burning, aching, gnawing, throbbing, shooting, constricting, other)

Answer 8

Can you describe the sensation?(dull, sharp, burning, aching, gnawing, throbbing, shooting, constricting, other)

Question 9

How would you describe the intensity? (VAS 0-10)

Answer 9

How would you describe the intensity? (VAS 0-10)

Question 10

Has it been constant or does it come and go?

	a. Constant: present 75% of the day or more
	b. Episodic: tied to a particular event or time of the day
	c. Intermittent: not tied to a particular event or time of day

Answer 10

Has it been constant or does it come and go?

	a. Constant: present 75% of the day or more
	b. Episodic: tied to a particular event or time of the day
	c. Intermittent: not tied to a particular event or time of day

Question 11

Has it been getting better, worse or staying about the same?

Answer 11

Has it been getting better, worse or staying about the same?

Question 12

Have you found anything that makes it better?

Answer 12

Have you found anything that makes it better?

Question 13

Have you found anything that makes it worse?

Answer 13

Have you found anything that makes it worse?

Question 14

Has there been a change in any bodily function? (urination, defacation, respiration, respiration, digestion, vision, sexual, other)

Answer 14

Has there been a change in any bodily function? (urination, defacation, respiration, respiration, digestion, vision, sexual, other)

Question 15

Has it affected your daily activities in any way?

Answer 15

Has it affected your daily activities in any way?

Question 16

Have you tried any store bought, prescription, or home remedies?
a. If yes, what was the effectiveness?

Answer 16

Have you tried any store bought, prescription, or home remedies?
a. If yes, what was the effectiveness?

Question 17

Have you sought other professional care for this condition?

a. If yes, what was the effectiveness?

Answer 17

Have you sought other professional care for this condition?

a. If yes, what was the effectiveness?

Question 18

Is there anything else you would like to discuss or important for me to know?

Answer 18

Is there anything else you would like to discuss or important for me to know?