THE HPI
What belongs in HPI? - ANSSubjective Information
What is an HPI? - ANSStory of symptoms and events that led to the patient's ED visit
Onset - ANSWhen did the complaint begin?
Timing - ANSHas it been constant, intermittent, or waxing and waning?
Location - ANSWhere is the discomfort?
Quality - ANSDoes it feel sharp, dull, aching, cramping...?
Severity - ANSHow bad is it? Mild, mod, severe or 0-10?
Modifying Factors - ANSWhat makes it better? What makes it worse?
Associated Sx - ANSDo any other symptoms accompany the complaint?
Context - ANSIs there anything else that's important?
HPI Formula - ANS1) Begin with the age and sex of the patient
2) State the complaint and onset
3) Describe the quality, location, and timing
4) Has anything improved or worsened it?
5) List associated symptoms
6) List pertinent negatives
7) Describe any other important context specific to that patient
Writing A Good HPI - ANSThe more closely you can stick to the formula, the better your HPI will
be.
Try to remember the pt's answers as a general story, rather than focusing on remembering the
individual facts.
, Groups all related information together; finish describing all the details of one complaint before
moving on to the next.
Try to word your HPI as a doctor would speak: translate things that the patient says into
phrasing that sounds more like a doctor. When in doubt, you may always document direct
patient quotes.
Re-Wording PT Statements - ANS"Symptoms were unchanged by tums.
HPI Dont's - ANSdon't use days of the week for onset.
Don't use the word "got."
Don't start every sentence the same.
Don't document slef-diagnoses in the HPI.
don't include PMHx, PSHx, or SHx that is not relevant to the chief complaint. (Document only
medical histories, surgeries, or social habits that directly relate to the patient's chief complaint).
Similar Symptoms - ANSIs it common to encounter patients in the ED who are seeking
evaluation for a symptom they have experienced at some time in the past.
For these patients:
- Anything new or different about present symptoms
- how long ago the similar symptoms occurred
- If they sought professional treatment at that time
- Any result or diagnosis from previous evaluations
Previous Evaluation - ANSAnytime a patient has been evaluated by another healthcare provider
for a similar complaint. It is important to document:
- What symptoms prompted the prior evaluation?
- How long ago did the prior evaluation occur?
- Who did they see? (Name and specialty)
- What treatment did they receive? Did it help?
- What diagnosis was given?
If the patient has had any prior testing or study related to their complaint, it is important:
- Specific name of the test (lab, XR, CT, MRI)
- Date
- Specific results
Document the prior test results may save us from repeating the same study for their current
visit.
What belongs in HPI? - ANSSubjective Information
What is an HPI? - ANSStory of symptoms and events that led to the patient's ED visit
Onset - ANSWhen did the complaint begin?
Timing - ANSHas it been constant, intermittent, or waxing and waning?
Location - ANSWhere is the discomfort?
Quality - ANSDoes it feel sharp, dull, aching, cramping...?
Severity - ANSHow bad is it? Mild, mod, severe or 0-10?
Modifying Factors - ANSWhat makes it better? What makes it worse?
Associated Sx - ANSDo any other symptoms accompany the complaint?
Context - ANSIs there anything else that's important?
HPI Formula - ANS1) Begin with the age and sex of the patient
2) State the complaint and onset
3) Describe the quality, location, and timing
4) Has anything improved or worsened it?
5) List associated symptoms
6) List pertinent negatives
7) Describe any other important context specific to that patient
Writing A Good HPI - ANSThe more closely you can stick to the formula, the better your HPI will
be.
Try to remember the pt's answers as a general story, rather than focusing on remembering the
individual facts.
, Groups all related information together; finish describing all the details of one complaint before
moving on to the next.
Try to word your HPI as a doctor would speak: translate things that the patient says into
phrasing that sounds more like a doctor. When in doubt, you may always document direct
patient quotes.
Re-Wording PT Statements - ANS"Symptoms were unchanged by tums.
HPI Dont's - ANSdon't use days of the week for onset.
Don't use the word "got."
Don't start every sentence the same.
Don't document slef-diagnoses in the HPI.
don't include PMHx, PSHx, or SHx that is not relevant to the chief complaint. (Document only
medical histories, surgeries, or social habits that directly relate to the patient's chief complaint).
Similar Symptoms - ANSIs it common to encounter patients in the ED who are seeking
evaluation for a symptom they have experienced at some time in the past.
For these patients:
- Anything new or different about present symptoms
- how long ago the similar symptoms occurred
- If they sought professional treatment at that time
- Any result or diagnosis from previous evaluations
Previous Evaluation - ANSAnytime a patient has been evaluated by another healthcare provider
for a similar complaint. It is important to document:
- What symptoms prompted the prior evaluation?
- How long ago did the prior evaluation occur?
- Who did they see? (Name and specialty)
- What treatment did they receive? Did it help?
- What diagnosis was given?
If the patient has had any prior testing or study related to their complaint, it is important:
- Specific name of the test (lab, XR, CT, MRI)
- Date
- Specific results
Document the prior test results may save us from repeating the same study for their current
visit.
