Download - Patient History Questions

8/12/2019 Patient History Questions

http://slidepdf.com/reader/full/patient-history-questions 1/4



3b, 2ap s%ear, %a%%ogra%, cholesterol?

Family Hx:Can you tell a bit about your father/s health (age, or cause of death)? iagnosed$ith anything?

#o$ bout your %other?+rothers?Sisters?Grandparents?Grandchildren?Any history of hypertension, stroke, diabetes, thyroid'renal disease? Arthritis, 3+,4ung disease, %ental illness (suicide), substance abuse?

Personal/Social History:What do you do for a li&ing?#o$ far along in school did you get?

What is it like at ho%e? Any significant others? #o$ is the relationship?Any significant sources of stress (i%%ediate' on!going)?5eligious'spiritual beliefs?Acti&ities of aily li&ing (especially elderly)?

o you e ercise %uch?What is your usual daily food intake? Caffiene?Any alternati&e health care?

Re ie! of Systems "#ons of $uestions% Start &road'()arro! it Do!n*:General- What is your usual $eight? #a&e you had significant loss'gain?

Any recent $eakness, fatigue, fe&er?

Skin- #a&e you noticed any changes in your skin (rash, sores, lu%ps)?

HEENT- #ead- #o$/s the old noggin? Any headaches, dizziness, light!headedness?

6yes- #o$ is your &ision? Any changes? Any pain, redness,double'blurred &ision? What about glauco%a7 any cataracts?

6ars- #o$ is your hearing? Any changes? Any ringing, earaches,infection? o you use hearing aids?

8ose- o you ha&e any nasal'sinus trouble? 0re*uent colds, stuffiness,nosebleeds, hayfe&er?

3hroat-#o$ is your teeth and gu%s? When $as the last ti%e you $ent tosee the dentist? Any soreness' sores? Sore!throats?

Neck- #o$ is your neck, any recent pain or stiffness? Breasts- #a&e you noticed any recent abnor%al changes in your breasts? 2ain,

lu%ps, discharge? Respirator - #o$ is your breathing'lungs? #a&e you had any recent trouble? Any