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Freehand
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Issue #1
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Issue #1
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Location #1
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"Patient presents with"
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"Patient Also Presents with"
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Pain Location ("Pain to the___")
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Photo of Foot
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When did it Start? #1
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Onset
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Days, weeks, months?*
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How did it start?
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Freehand
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Positive Trauma
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What Type of Trauma?
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Current Therapy #1
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Current Therapy
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Has Self Treatment Helped?
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Has pt seen another doctor for this issue?
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Prescribed Any Medications by a Doc?
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Advanced Studies Done
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Advanced Studies/Labs Done?
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Imaging/Lab work Results* ("which show___")?
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Freehand
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Previously Had This Condition? #1
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Has Patient Had this Issue Before?
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Previous treatment*
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Has Patient Had Rx Orthotics Before?
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Quality of Pain #1
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Quality
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Worst When?
• • •
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Quality Comments
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Infection #1
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Signs of infection
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If YES, what signs of infection
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Pain Rating #1
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Worst Pain Rating
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Current Pain Rating
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Course #1
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Course
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Course Comments
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Modifying Factors #1
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Modifying Factors (WORSE)
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Modifying Factors (BETTER)
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Modifying Factors Comments
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Associated Symptoms #1
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Associated Symptoms
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Associated Symptoms Comments
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Issue #2
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2nd Issue
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Location #2
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Pain Location ("pain to the___")
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Freehand
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When did it Start? #2
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Onset
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Days, weeks, months?*
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How did it start?
• • •
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Freehand
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Positive Trauma2
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What Type of Trauma?
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Current Therapy #2
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Current Therapy
• • •
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Has Self-Treatment Helped*
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Has pt seen another doctor for this issue?
• • •
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Prescribed Any Medications by a Doc?
• • •
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Freehand
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Advanced Studies/Lab Done2
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Advanced Studies Done?
• • •
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Imaging/Lab work Results* ("which show___")?
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Previously Had This Condition? #2
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Has Patient Had This Issue Before?
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Previous treatment*
• • •
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Previously Prescribed Custom Orthotics?
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Quality of Pain #2
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Quality
• • •
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Worst When?
• • •
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Quality Comments
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Infection #2
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Signs of infection
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If YES, what signs of infection
• • •
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Pain Rating #2
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Worst Pain Rating
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Current Pain Rating
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Course #2
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Course
• • •
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Course Comments
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Modifying Factors #2
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Modifying Factors (WORSE)
• • •
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Modifying Factors (BETTER)
• • •
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Modifying Factors Comments
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Associated Symptoms #2
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Associated Symptoms
• • •
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Associated Symptoms Comments
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Issue #3
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3rd Issue
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Freehand
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Pre-Made HPIs
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Heel Pain Subjective
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"Patient presents with"
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"Patient Also Presents with"
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Which Side
• • •
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When Did it Start?
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Previous treatment
• • •
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High heel wearer
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Has patient had custom orthotics?
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Anything Additional for HPI
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Bunion/Tailor's Pain Subjective
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"Patient presents with"
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"Patient Also Presents with"
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Which Side
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When Did it Start?
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Previous treatment
• • •
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High heel wearer
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Family Hx of Bunions
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Previously Prescribed Custom Orthotics?
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Anything Additional
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Hammertoe Pain
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"Patient presents with"
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"Patient Also Presents with"
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Which Side
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When Did it Start?
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Previous treatment
• • •
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Previous toe surgery?
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Anything Additional
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Ball of Foot Pain
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"Patient presents with"
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"Patient Also Presents with"
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Location
• • •
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When Did it Start?
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Previous treatment
• • •
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Previously Prescribed Custom Orthotics?
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High heel wearer
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Anything Additional
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Injury
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"Patient presents with"
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"Patient Also Presents with"
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Location "at the ____"
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When Did it Start?
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What Type of Trauma?
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Current Therapy
• • •
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Has Self-Treatment Helped*
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Prescribed Any Medications by a Doc?
• • •
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Has pt seen another doctor for this issue?
• • •
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Advanced Studies Done
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Advanced Studies Done?
• • •
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Imaging/Lab Work Results ("Results show___")?
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Current pain level
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Freeform
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Rash
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"Patient presents with"
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"Patient Also Presents with"
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Location "to the____"
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When Did it Start?
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Course
• • •
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Previous Therapies
• • •
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Has the Previous Treatment helped?
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Freehand
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Soft Tissue Mass
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"Patient presents with"
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"Patient Also Presents with"
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Location "at the____"
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When Did it Start?
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Course
• • •
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Freehand
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Wart
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"Patient presents with"
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"Patient Also Presents with"
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Which Side
• • •
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When Did it Start?
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Previous treatment
• • •
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Any improvement with therapy?
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Anything additional?
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Tendonitis Subjective
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"Patient presents with"
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"Patient Also Presents with"
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Location "at the____"
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When Did it Start?
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Previous treatment
• • •
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Modifying Factors (BETTER)
• • •
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Modifying Factors (WORSE)
• • •
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Anything Additional for HPI
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