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on
on
fid Marvin Webster
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en
en
History tia
tia
How can I help you today?
l
l
Do you have any other symptoms or concerns we should discuss?
Do you have any allergies, such as medications, food and/or latex, for example?
Are you taking any prescription medications?
Are you taking any over-the-counter or herbal medications?
Can you tell me about any current or past medical problems you have had?
Any previous medical, surgical, or dental procedures?
C
on
Do you now or have you ever smoked or chewed tobacco?
Have you had any contact with other sick people?
fid
Are you sexually active?
en
Do you experience: chest pain discomfort or pressure; pain/pressure/dizziness with exertion or
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getting angry; palpitation; decreased exercise tolerance; blue/cold fingers or toes?
l
Do you have any of the following: dizziness, fainting, spinning room, seizures, weakness,
numbness, tingling, tremor?
Do you have any of the following problems: fatigue, difficulty sleeping, unintentional weight loss
or gain, fevers, night sweats?
How high was your fever?
C
C
When you urinate, have you noticed: pain, burning, blood, difficulty starting or stopping,
on
on
dribbling, incontinence, urgency during day or night or any changes in frequency?
fid
fid
en
en
1
tia
tia
l
l
,C
C
on
on
How severe (1-10) is the pain in your chest?
fid
fid
Do you have any pain in your chest?
en
en
Have you noticed: any bruising, bleeding gums, nose bleeds or other sites of increased
tia
tia
bleeding?
l
l
Do you have any of the following: heat or cold intolerance, increased thirst, increased sweating,
frequent urination, change in appetite?
Do you have any problems with: nervousness, depression, lack of interest, sadness, memory
loss, or mood changes, or ever hear voices or see things that you know are not there?
Do you awaken at night coughing?
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What treatments have you had for your cough?
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What are the events surrounding the start of your cough?
fid
Is there any pattern to your cough?
en
Does anything make your cough better or worse?
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Do you have HIV?
l
Do you drink alcohol? If so, what do you drink and how many drinks per day?
Have you had a cough like this before?
Do you have problems with: nausea, vomiting, constipation, diarrhea, coffee grounds in your
vomit, dark tarry stool, bright red blood in your bowel movements, early satiety,
bloating?
C
C
Do you use recreational drugs? If so, what?
on
on
Do you have problems with: muscle or joint pain, redness, swelling, muscle cramps, joint
fid
fid
stiffness, joint swelling or redness, back pain, neck or shoulder pain, hip pain?
en
en
2
tia
tia
l
l
, C
C
on
on
Are you coughing up any sputum?
fid
fid
When did your cough start?
en
en
Do you have any problems with: headaches that don’t go away with aspirin or Tylenol
tia
tia
(acetaminophen), double or blurred vision, difficulty with night vision, problems hearing,
l
l
ear pain, sinus problems, chronic sore throats, difficulty swallowing?
Have you ever been hospitalized?
What is your name?
Do you have pain anywhere? If so, where?
C
on
Physical Exams
fid
Temperature
en
Skin, hair, nails: inspect skin overall
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Chest wall and lungs: auscultate lungs
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Heart: auscultate heart
Abdomen: visual inspection abdomen
Extremities: visual inspection extremities
Musculoskeletal: inspect for muscle bulk and tone
Vitals: pulse
C
C
Chest wall and lungs: auscultate lungs
on
on
Vitals: respiration
fid
fid
Vitals: pulse
en
en
3
tia
tia
l
l
C
on
on
fid Marvin Webster
fid
en
en
History tia
tia
How can I help you today?
l
l
Do you have any other symptoms or concerns we should discuss?
Do you have any allergies, such as medications, food and/or latex, for example?
Are you taking any prescription medications?
Are you taking any over-the-counter or herbal medications?
Can you tell me about any current or past medical problems you have had?
Any previous medical, surgical, or dental procedures?
C
on
Do you now or have you ever smoked or chewed tobacco?
Have you had any contact with other sick people?
fid
Are you sexually active?
en
Do you experience: chest pain discomfort or pressure; pain/pressure/dizziness with exertion or
tia
getting angry; palpitation; decreased exercise tolerance; blue/cold fingers or toes?
l
Do you have any of the following: dizziness, fainting, spinning room, seizures, weakness,
numbness, tingling, tremor?
Do you have any of the following problems: fatigue, difficulty sleeping, unintentional weight loss
or gain, fevers, night sweats?
How high was your fever?
C
C
When you urinate, have you noticed: pain, burning, blood, difficulty starting or stopping,
on
on
dribbling, incontinence, urgency during day or night or any changes in frequency?
fid
fid
en
en
1
tia
tia
l
l
,C
C
on
on
How severe (1-10) is the pain in your chest?
fid
fid
Do you have any pain in your chest?
en
en
Have you noticed: any bruising, bleeding gums, nose bleeds or other sites of increased
tia
tia
bleeding?
l
l
Do you have any of the following: heat or cold intolerance, increased thirst, increased sweating,
frequent urination, change in appetite?
Do you have any problems with: nervousness, depression, lack of interest, sadness, memory
loss, or mood changes, or ever hear voices or see things that you know are not there?
Do you awaken at night coughing?
C
What treatments have you had for your cough?
on
What are the events surrounding the start of your cough?
fid
Is there any pattern to your cough?
en
Does anything make your cough better or worse?
tia
Do you have HIV?
l
Do you drink alcohol? If so, what do you drink and how many drinks per day?
Have you had a cough like this before?
Do you have problems with: nausea, vomiting, constipation, diarrhea, coffee grounds in your
vomit, dark tarry stool, bright red blood in your bowel movements, early satiety,
bloating?
C
C
Do you use recreational drugs? If so, what?
on
on
Do you have problems with: muscle or joint pain, redness, swelling, muscle cramps, joint
fid
fid
stiffness, joint swelling or redness, back pain, neck or shoulder pain, hip pain?
en
en
2
tia
tia
l
l
, C
C
on
on
Are you coughing up any sputum?
fid
fid
When did your cough start?
en
en
Do you have any problems with: headaches that don’t go away with aspirin or Tylenol
tia
tia
(acetaminophen), double or blurred vision, difficulty with night vision, problems hearing,
l
l
ear pain, sinus problems, chronic sore throats, difficulty swallowing?
Have you ever been hospitalized?
What is your name?
Do you have pain anywhere? If so, where?
C
on
Physical Exams
fid
Temperature
en
Skin, hair, nails: inspect skin overall
tia
Chest wall and lungs: auscultate lungs
l
Heart: auscultate heart
Abdomen: visual inspection abdomen
Extremities: visual inspection extremities
Musculoskeletal: inspect for muscle bulk and tone
Vitals: pulse
C
C
Chest wall and lungs: auscultate lungs
on
on
Vitals: respiration
fid
fid
Vitals: pulse
en
en
3
tia
tia
l
l
