|
GGeneral Survey
1.
Age, race, sex, Ht, Wt
2.
Reason for seeking care
3.
HX present illness with Critical characteristics: location,
character & quality, severity
timing, setting, aggravating or relieving
assoc. factors, perceptions.
4.
Past health: operations, hospitalizations,
immunizations
5.
Pertinent family health (cancer, heart disease,
diabetes)
6.
Cultural background
MMental Status
1.
Person, place, time, situation
SSkin, Hair, Nails
1.
Previous HX skin disease (allergies, hives,
psoriasis, eczema, dermatitis, cancer)
2.
Change in pigmentation
3.
Pruritis
4.
Excessive bruising
5.
Rash or lesions
6.
Hair loss
7.
Change in nails
8.
Environmental or occupational hazards
9.
Self-care behaviors |
EENT
1.
Visual difficulty (decreased acuity, blurring, blind
spots)
2.
Eye pain, redness or swelling
3.
Watering or discharge
4.
HX injury or eye surgery
5.
Glaucoma
6.
Glasses or contacts, last vision test
7.
Ringing in ears
8.
Earache, ear infection, discharges; Hearing loss
9.
Environmental noise
10.
Last hearing test
11.
Nasal discharge
12.
Frequent colds
13.
Sinus pain
14.
Nasal trauma, nosebleeds
15.
Altered smell
16.
Mouth sores or lesions
17.
Sore throats;
Bleeding gums;
Gingivitis; Toothache; Voice changes
18.
Dysphagia
19.
Daily dental care, dentures |
Heart & Neck Vessels
1.
Chest pain
2.
Dyspnea on exertion
3.
Orthopnea
4.
Fatigue
5.
Cyanosis or pallor
6.
Edema
7.
Past cardiac HX
8.
Family cardiac HX
9.
Personal cardiac risk factors (BP, obesity, diabetes,
smoking, alcohol, sedentary lifestyle)
10.
HX chronic emphysema, bronchitis
11.
Cardiac medications |
