Medical History Checklist Flashcards
1
Q
CC
A
Chief Complaint
2
Q
HPI
A
History of Present Illness Onset: date/time/duration Provocation Palliative Quality Quantified Regionality Radiation Symptoms: (Associated) Timing: occurence, onset
3
Q
PMH
A
Past Medical History General Health Hospitalizations Surgical Procedures Illnesses Injuries Medications Allergies Immunizations
4
Q
FH
A
Family History Cancer Hypertension Heart Disease Diabetes Respiratory Problems Seizures Bleeding Disorders Age/health (grandparents)
5
Q
SH
A
Social History Occupation Education Socioeconomic Status Living Situation Sexual History Physical Activity Diet Sleep Caffeine Use Alcohol Use Tobacco Use Illicit Drug Use Military History Safe At Home Prescription Drug Use Out of Country Recently
6
Q
ROS
A
General Skin Head Ears Eyes Nose/Sinuses Mouth/Throat Neck Lymph Nodes Breasts Respiratory Cardiovascular Gastrointestinal Genitourinary Obstetrics/Gynecology Extremities/Musculoskeletal Neurologic Hematologic Endocrine
7
Q
General
A
Weight Changes Fatigue Malaise Fever/chills Sweats/nights Sweats Weakness
8
Q
Skin
A
Rashes/sores/lesions Lumps/masses Pruritus (Itching) Dryness/moisture Hair/nail changes
9
Q
Head
A
Headaches
Head Trauma
Dizziness/Vertigo
Syncope/LOC
10
Q
Ears
A
General Hearing Status Otalgia (earaches) Past Infections Drainage/discharge Tinnitus (ringing in the ears)
11
Q
Eyes
A
General Vision status Glasses/contacts Last eye exam Pain/redness/tearing Diplopia/blurriness H/O trauma/foreign bodies
12
Q
Nose/Sinuses
A
Sinus Pain Epistaxis (nose bleed) Nasal congestion Nasal drainage Frequent colds Sneezing
13
Q
Mouth/ Throat
A
Dental Hygiene Toothaches Last dental Exam Pain/Soreness Hoarseness
14
Q
Nech
A
PAin
Stiffness/ Limited ROM (range of motion)
15
Q
Lymph Nodes
A
Tenderness/enlargements
16
Q
Breasts
A
Pain
Lumps/masses
Nipple Change/Discharge
Self Exams
17
Q
Respiratory
A
Pleuritic Chest Pain Cough/Sputum Hemoptysis (blood in sputum) Wheezing or H/O asthma H/O bronchitis TB or past exposure Last PPD or CXR
18
Q
Cardiovascular
A
Pain Palpitations Diaphoresis SOB/Dyspnea Orthopenea (SOB laying flat)/ PND (waking and gasping for air) Edema H/O Hypertension H/O Hearth murmurs H/O heart Problems EKG/ other dx testing
19
Q
Gastrointestinal
A
Appetite Food intolerance Dysphagia (solid/liquid) Heartburn Nausea/vomiting Change in bowel habits Diarrhea/constipation Rectal Bleeding/ Melena (tarry stool) Hemorrhoids H/O PUD (peptic ulcer disease) H/O Jaundice H/O Appendix/ Gall Bladder Disease
20
Q
Genitourinary
A
Change of Frequency Change of Force of Stream Normal Color or Change in Color Hesitancy/difficulty to initiate Pain/Dysuria Dribbling/Incontinence H/O infections H/O hematuria Penile/Vaginal discharge H/O STI's/ Treatment Libido WOMEN ONLY: dyspareunia (painful intercourse) MEN ONLY: Scrotal pain/mass/edema Erectile problems, Self Testicular Exam
21
Q
OB/GYN
A
Menarche Last Menstrual Period Number of Pregnancies Pregnancy Complications Delivery Complications Living Children Abortions/Miscarriages Last Papsmear Menopausal Symptoms
22
Q
Extremities/Musculoskeletal
A
Intermittent Claudication Varicosities Decreased Strength Decreased ROM Joint Swelling/ redness Joint Stiffness/pain H/O Bone/Joint Infections H/O Fractures/dislocations H/O Back pain/disk disease H/O Sciatica
23
Q
Neurologic
A
H/O Concussion H/O convulsions/seizures H/O infections/meningitis Mood/ Emotional Stability Memory Loss/ Problems Tremors Numbness/ Sensory Loss Paresthesia (Pins/Needles)
24
Q
Hematologic
A
Easy Bruising Bleeding (Gums, Skin) H/O Transfusions H/O Anemia H/O Blood Diseases
25
Endocrine
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Intolerance to Heat/Cold
Nervousness
Sleeplessness
Polyphagia/uria/dipsia
Nocturia
Tested For Diabetes
H/O Thyroid Disease
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