WGU D117 Advanced Health Assessment Documentation Form – 2026 Update with complete solutions.

WGU D117 Advanced
Health Assessment
Documentation Form
Updated with complete
solutions.
WGU D117 – Advanced Health Assessment Documentation Form


Student Name: __________________________________________
Date of Assessment: _____________________________________
Course: WGU D117 – Advanced Health Assessment
Preceptor/Instructor: ____________________________________


1. Patient Information


Patient Initials: __________________
Age: __________
Gender: ☐ Male ☐ Female ☐ Other
Ethnicity: __________________________
Source of Information: ☐ Patient ☐ Family ☐ Medical Record ☐ Other


Chief Complaint (CC):


History of Present Illness (HPI):

,(Include OLDCARTS – Onset, Location, Duration, Characteristics, Aggravating factors,
Relieving factors, Timing, Severity)


Onset: _______________________________________________


Location: _____________________________________________


Duration: _____________________________________________


Characteristics: _______________________________________


Aggravating Factors: __________________________________


Relieving Factors: _____________________________________


Timing: ______________________________________________


Severity (0–10): ______________________________________


Narrative Description:


2. Past Medical History


Chronic Illnesses:
☐ Hypertension
☐ Diabetes
☐ Asthma
☐ Heart Disease
☐ Thyroid Disorder
☐ Other: ______________________________________


Childhood Illnesses:

, Hospitalizations:


Surgeries/Procedures:


Immunizations:
☐ Up to date
☐ Not up to date
☐ Unknown


Allergies:
Medication: _________________________________________________
Food: ______________________________________________________
Environmental: ______________________________________________


Reaction: ___________________________________________________


3. Medications
Medication Dose Route Frequency Indication