LBRRY.cr
Patient History & Examination
NAME D.O.B/SEX MRN ADMISSION DATE CURR
PRESENTING COMPLAINT PAIN
Main symptom/s: Site
Onset
Referral from: self, GP, clinic, other Character
Radiation
History leading to this complaint & Systemic enquiry: Associations
Timing
Exacerbation/alleviation
Severity
PAST MEDICAL HISTORY MEDICATION
Medical/psychiatric:
Drug
Indication
Dose
Frequency
Surgical:
Side effects
Allergies
Compliance
SOCIAL & FAMILY HISTORY
Smoking Alcohol Recreational drugs OTHER
Patient History & Examination
NAME D.O.B/SEX MRN ADMISSION DATE CURR
PRESENTING COMPLAINT PAIN
Main symptom/s: Site
Onset
Referral from: self, GP, clinic, other Character
Radiation
History leading to this complaint & Systemic enquiry: Associations
Timing
Exacerbation/alleviation
Severity
PAST MEDICAL HISTORY MEDICATION
Medical/psychiatric:
Drug
Indication
Dose
Frequency
Surgical:
Side effects
Allergies
Compliance
SOCIAL & FAMILY HISTORY
Smoking Alcohol Recreational drugs OTHER