Patient History Template
PATIENTDETAILS AGE INPATIENT OUTPATIENTPRIMARYCARE
SEX WARD
PRESENTINGCOMPLAINT PASTMEDICALHISTORY
HISTORYOFPRESENTINGCOMPLAINT
ÉÉÉ
CHARACTER
RADIATION FAMILYMEDICALHISTORY
ASSOCIATED SYMPTOMS
TIME
EXACERBATING RECEIVINGFACTORS
SEVERITY
DRUGHISTORY SOCIALHISTORY
ALLERGIES OCCUPATION
PRESCRIBED HOMELIFE SUPPORT SAFE
RECREATIONAL ALCOHOL SMOKING
INHALERS DIET EXERCISE
CONTRACEPTIVES SEX PREGNANCY
OVERTHECOUNTER
TOPICAL
SUPPLEMENTS
IDEAS
CONCERNS
EXPECTATIONS
EXTRANOTES