Fred O Macintyre V5 PC
Interview
How can I help today?
What are the events surrounding the start of your chest pain?
When did the pain in your chest start?
Does the pain in your chest radiate someplace else? Where?
Where more precisely is the pain in your chest?
What does the pain/discomfort in your chest feel like?(Squeezing, pressure, crushing, burning,
stabbing, aching, tingling, suffocating)
Does your pain awaken you from sleep?
Is the chest pain worse with deep inspiration?
Does anything make the pain in your chest better or worse?
How often does this chest pain occur?
How severe (1-10) is the pain in your chest?
Do you have a problem with fatigue/tiredness?
Do you have unusual heartbeats (Palpitations)?
Do you have any other symptoms or concerns we should discuss?
Have you noticed swelling in any part of your body?
Do you have episodes of excessive sweating?
Have you had any more stress in your life lately?
PMH/FH/SH as needed
Any new or recent change in medications?
Do you have any allergies?
ROS
Do you have problems with dizziness, fainting, spinning room, seizures, weakness, numbness,
tingling, or tremor?
Do you have any problem with fatigue, difficulty sleeping, unintentional weight loss or gain,
fevers, or night sweats?
When you urinate, have you noticed any pain, burning, blood, difficulty starting or stopping,
dribbling, incontinence, urgency during day or night, or any changes in frequency?