| 
               HPI 
  
  
  
  
 | 
          
            
               | 
          
          
| 
               Date symptoms began 
  
  
  
  
 | 
          
            
               Onset / Timing 
  
  
  • • •
  
 | 
          
          
| 
               Severity Comments 
  
  
  
  
 | 
          
            
               Severity 
  
  
  
  
 | 
          
          
| 
               Pain Comments 
  
  
  
  
 | 
          
            
               Pain 
  
  
  • • •
  
 | 
          
          
| 
               Location 
  
  
  
  
 | 
          
            
               Location 
  
  
  • • •
  
 | 
          
          
| 
               occupation 
  
  
  
  
 | 
          
            
               | 
          
          
| 
               subjective normal 
  
  
  
  
 | 
          
            
               | 
          
          
