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GENERAL NML
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Fever
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Chills
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Night Sweats
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Loss of Appetite
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Unexplained Weight gain
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Unexplained Weight Loss
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Explained Weight loss
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Weakness
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EYES WNL
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Blurred Vision
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Double Vision
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Eye Pain
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Eye Irritation
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Eye Discharge
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Decreased Visual Acuity
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Photophobia
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History Glaucoma
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ENT: WNL
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Earache
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Tinnitis
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Decreased Hearing
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Dysphagia
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Epistaxis
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Frequent Sore Throat
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Prolonged Hoarseness
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Sinus Congestion
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Uses Hearing Aid
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CARDIOVASCULAR: WNL
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CARDIOVASCULAR: as per HPI
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Exerional Chest Pain
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Ectopy
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Non-exertional chest pain
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Syncope / Presyncope
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Palpitations (fast heart beat)
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Irregular Heart Beat
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Dyspnea on Exertion
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Orthopnea
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Shortness of Breath
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PND
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Swollen Ankles
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RESPIRATORY: WNL
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Cough
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Occasional Shortness of Breath
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Occasional Wheezing
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Hemoptysis
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Sputum Production
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Pleuritic Chest Pain
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GASTROINTESTINAL: WNL
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Nausea
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Vomiting
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Diarrhea
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Constipation
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Change in Bowel Habit
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Abdominal Pain
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Hematochizia
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Melena
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Jaundice
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Hearburn
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Incontinence
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Bloating
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GU: WNL
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Dysuria
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Hematuria
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Urinary Frequency
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Incontinence
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Nocturia
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Hesitant Urination
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GYN: WNL
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Vaginal Discharge
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Menorhagia
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Metrorhagia
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Breast Mass or Tenderness
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Discuss HIV?
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Desires HRT?
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MALE SEXUALITY: WNL
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Erectile Dysfunction
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Decreased Libido
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Discuss HIV/STD
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MUSCULOSKELETAL: WNL
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Back Pain
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Muscle Weakness
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Arthritis
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Muscle Cramping
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Joint Pain
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Muscle Stiffness
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Claudication
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Edema
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SKIN: WNL
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Rashes
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Itching
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Dry Skin
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Suspicious Moles or Lesions
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NEUROLOGIC: WNL
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Headache
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Limb Weakness
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Numbness
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Parasthesias
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Seizures/Convulsions
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Syncope
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Tremor
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Dizziness/Vertigo
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Stroke/TIA
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PSYCHOLOGICAL: WNL
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Anxiety
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Depression
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Memory Loss
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Suicidal Ideations
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Homicidal Ideations
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Insomnia
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ENDOCRINE: WNL
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Cold / Heat Intolerance
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Polyphagia
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Polyuria
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Polydypsia
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Unexplaied Weight Gain
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Weight Loss
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HEME / LYMPHATIC: WNL
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Excessive Bruising
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Bleeding
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Lymphadenopathy
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Anemia
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Current Anticoagulant Use
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ALLERGIC / IMMUNOLOGIC: WNL
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HIVES
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Seasonal Allergies
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Frequent Infections
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SLEEP APNEA: WNL
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Daytime Somnolence
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Snoring
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Fatigue
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Lack of Energy
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