History Tacking

GOOD HISTORY=GOOD DOCTOR

1.Name..

2.Age 3.Sex.

4.Occupation.

5.Marital State: Singl

Divorcid Marrid Widow

No.of children Duration

Age of Oldest Age of youngest:

6.Residence:

7. Special Habits:

Smoking Type: Ciggarite Water pipe

Amount.. duration

If stopped ? Why?...............................................................................................................................

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Excessive : Tea coffee ..Cup / day

Qut chewer:..hour/day

8.D.O.A:..

9.Through : ER Reffered Electivily

Chief Complaint The pationt is complaining of

Since.

Chaif complaint

Personal History

Chronic disease:

D.M HTN TB Asthma peptic ulcer

Rheumatic arthritis cardiac problem skin disease

Duration..

Manifested by

.

Investigation by..

.

Treated by

.

Complicated by

Surgical Operations

*Type.. *DATE.

*Site.. * blood trasfusion

Amount

Why

.

Past History

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1.Analysis of complaint

2.Symptoms of the related system

3.Investigation &

treatment(related disease)

History of present Illness

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1.Date of menarch and menopause

2.Frequency of period3. Regularity

4.Duration. 5.Amount of blood

6.History of intake of contraceptive pills......................................................................

*House: rental own

*Ventilation: good moderate

bad

*Water supply: good moderate

bad

*Electricity: good moderate bad

*Animal contact:..

Menstural and Obtetric History

Socio-economic History

Resp

iratory

Sy

stem

Dyspnea Tachypnea Bradypnea Wheezing

Cough ) ( Sputum Chest pain Hemoptysis

Last chest X-ray Asthma Tuberculosis Bronchitis

CVS Heart troubles Hypertension Rheumatic fever Heart murmur

Chest pain Palpitation Paroxysmal nocturnal

dyspnea (PND) Edema

Past ECG Past vascular clots GIT &

HBS

Troubles of swallowing Heartburn Appetite Nausea

Vomiting Bowel troubles Constipation Hemorrhoids Diarrhea Abdominal pain

Jaundice Hepatitis Liver troubles Gallbladder troubles

Stools (color & quantity)

Itchy rashes

Urog

enita

l System

Loins pain Polyuria Urgency Nocturia

Oliguria Anuria Color of urine Burning urination

Hematuria Urinary infections Renal stones Incontinence

Hesitancy Dribbling Hernias Genitalia pains

Menarche (F) regularity of periods (F)

Bleeding frequency (F) Amount of bleeding (F) Last menstrual (F) Dysmenorrhea (F)

Vaginal discharge (F) Abortions (F) ] [ Deliveries No. & Type

(F) ( 54)< Menopause age (F)

Mu

sculosk

eleta

l System

Muscles or joints pain Stiffness Arthritis Gout

Backache Muscle Weakness Movements limitations Hx trauma

Bone fractures Muscles cutting Neurologic

System

Fainting \ Blackouts Seizures Numbness

Loss of sensation Tingling Tremors Involuntary

movements

Hematology Anemia ) ( Hemophilia

Past transfusion Transfusion reactions Endocrine Heat ntolerance Cold intolerance

Excessive hunger Excessive sweating Change in extremities

sizes Excessive thirst

: Group D

Systemic Review