History
How can I help you today?
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 medicati
...
History
How can I help you today?
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?
Do you now or have you ever smoked or chewed tobacco?
Have you had any contact with other sick people?
Are you sexually active?
Do you experience: chest pain discomfort or pressure; pain/pressure/dizziness with exertion or
getting angry; palpitation; decreased exercise tolerance; blue/cold fingers or toes?
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?
When you urinate, have you noticed: pain, burning, blood, difficulty starting or stopping,
dribbling, incontinence, urgency during day or night or any changes in frequency?
2
How severe (1-10) is the pain in your chest?
Do you have any pain i
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