|
Chief Complaint
• • •
|
CC Comments (or other)
|
|
HPI - Abdominal Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Ankle Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Arm Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Elbow Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Foot Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Hand Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Headaches
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Hip Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Knee Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Leg Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Low Back Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Mid Back Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Nausea
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Neck Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Sciatica
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Shoulder Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Tendinitis
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - TMJ Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Upper Back Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
HPI - Wrist Pain
|
|
|
Location
• • •
|
Location Comments
|
|
CC status
|
CC Status Comments
|
|
Quality of pain
• • •
|
Quality of Pain Comments
|
|
Severity
• • •
|
Severity Comments
|
|
Duration
• • •
|
Duration Comments
|
|
Onset & Timing
|
Timing Comments
|
|
Context (type or dictate)
|
|
|
Relieving Factors
• • •
|
Relieving Factors Comments
|
|
Aggravating Factors
• • •
|
Aggravating Factors Comments
|
|
Associated Symptoms
• • •
|
Associated symptoms comments
|
|
|
|
|
Social History
|
|
|
Tobacco
• • •
|
tobacco comments
|
|
Alcohol Use
• • •
|
alcohol comments
|
|
|
|
|
Family History
|
|
|
Father's MH
• • •
|
father mh comments
|
|
Mother's MH
• • •
|
mother mh comments
|
|
Grandparent's MH
• • •
|
grandparents mh comments
|
|
Sibling(s)' MH
• • •
|
siblings mh comments
|
|
Children(s)' MH
• • •
|
children mh comments
|
|
ROS
|
|
|
General:
|
General +
• • •
|
|
General Comments
|
General -
• • •
|
|
GI:
|
GI +
• • •
|
|
GI comments
|
GI -
• • •
|
|
MSK:
|
MSK +
• • •
|
|
MSK comments
|
MSK -
• • •
|
|
Skin
|
Skin +
• • •
|
|
Skin comments
|
Skin -
• • •
|
|
Neurologic:
|
Neurologic +
• • •
|
|
Neuro comments
|
Neurologic -
• • •
|
