Make sure to answer these questions : 1. REASON FOR VISIT(LOCATION and SIDE OF BODY) Example : Right knee pain for 3 months
2. WHEN did your problem begin? Constant, or Come and Go?
3. HOW did your problem start ? Injury or Out of nowhere ?
4. What are the symptoms (pain, locking, clicking , numbness)?
5. What makes the problem Worse? / Better ?
6. Have you had any Xrays / MRIs for this problem? If so , where and when ?
9. Were you seen in the Emergency Room for this problem ?
10. Have you seen an Orthopedist for this problem? What did they say
11. What treatment have you had for this problem?
DO YOU HAVE PROBLEMS WITH THE FOLLOWING:
GENERAL fevers/chills sweats tiredness/fatigue weight loss EYES blurring double vision vision loss eye pain photophobia ENT ear pain/discharge hearing problems/ringing nosebleeds hoarseness difficulty swallowing HEART chest pain irregular heart beat passing out orthopnea swelling in legs LUNGS shortness of breath wheezing cough cough up blood BOWELS nausea/vomiting diarrhea constipation abdominal pain blood in stool black bowel movements URINARY burning loss of urine difficulty voiding infections blood in urine sexual dysfunction SKIN rash itching dryness strange lesions
NEUROLOGIC weakness seizures dizziness balance problems memory problems
MOOD depression anxiety sleep disturbance hallucinations suicidal thoughts ENDO cold or heat intolerance thirsty all the time peeing a lot large weight gain/loss BLOOD easy bruising anemia enlarged glands bleeding ALLERGY Itching frequent colds/infections HIV exposure