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Symptom Update
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Improvement?
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Pain # after tx
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|
Length of change
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2nd stage of pain
|
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Next pain #
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Status
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Comments
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|
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Temperature
• • •
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Energy
• • •
|
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Sleep
• • •
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Digestion
• • •
|
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Appetite
• • •
|
Thirst
• • •
|
|
Bowel Movements
• • •
|
Urination
• • •
|
|
Sweating
• • •
|
Stress
• • •
|
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Lungs
• • •
|
Cough?
• • •
|
|
Sputum?
• • •
|
EENT
• • •
|
|
Sputum?
• • •
|
Heart
• • •
|
|
Comments
|
|
|
Menstrual details
|
Menstrual history
|
|
Menstrual problems
• • •
|
Comments
|
|
Cycle length
|
Days bleeding
|
|
Ovulatory symptoms
• • •
|
Pre-menstrual symptoms
• • •
|
|
Period symptoms
• • •
|
Color of blood
• • •
|
|
Consistency of blood
• • •
|
Comments
|
|
LMC 1
|
Cylcle length
|
|
Days bleeding
|
Ovulatory symptoms
• • •
|
|
Pre-menstrual symptoms
• • •
|
Period symptoms
• • •
|
|
Color of blood
• • •
|
Consistency of blood
• • •
|
|
Comments
|
|
|
LMC 2
|
Cylcle length
|
|
Days bleeding
|
Ovulatory symptoms
• • •
|
|
Pre-menstrual symptoms
• • •
|
Period symptoms
• • •
|
|
Color of blood
• • •
|
Consistency of blood
• • •
|
|
Comments
|
|
|
LMC 3
|
Cylcle length
|
|
Days bleeding
|
Ovulatory symptoms
• • •
|
|
Pre-menstrual symptoms
• • •
|
Period symptoms
• • •
|
|
Color of blood
• • •
|
Consistency of blood
• • •
|
|
Comments
|
|
