|
HPI
• • •
|
Other HPI
|
|
Onset____select days/weeks from the next field
|
days/ weeks/ months/ years
|
|
Timing
• • •
|
Location
• • •
|
|
aspect of
|
|
|
Precipating/alleviating factor:worse with
• • •
|
Other
|
|
Better with
• • •
|
Other
|
|
Quality
• • •
|
Radiating
• • •
|
|
Associated symptoms
• • •
|
If pain where?
|
|
|
|
|
Default template below
|
|
|
Location
• • •
|
Location Comments
|
|
Quality
• • •
|
Quality Comments
|
|
Severity
|
Severity Comments
|
|
Onset / Timing
• • •
|
Duration Comments
|
|
Duration
• • •
|
Onset Comments
|
|
Context
• • •
|
Context Comments
|
|
Modifying Factors
• • •
|
Modifying Factors Comments
|
|
Associated Symptoms
• • •
|
Associated Symptoms Comments
|
|
Previous/Current Meds and Treatments
|
|
