Health History

BAM PPP FSF

1. biographical data

2. allergies

3. meds

4. history of present illness

5. past medical and surgical health

6. past illnesses/immunizations/injury

7. family history

8. review of systems

9. functional health assessment

10. wrap up questions

BAM

• gender

• ethnic background

• allergies

• medications

history of present illness

• what brings you in today?

• if ill, do OPQRSTUV

past medical and surgical health

• surgeries, hospitalizations, recent health exams

• family doctor check-up regularity

past illnesses/immunizations/injuries

• childhood illnesses

• accidents/injuries

• serious illnesses

• immunizations

family history

• history of illnesses or diseases specifically heart disease, cancer, diabetes

GENERAL review of systems

• noticed any weight loss/gain?

• fever, chills, night sweats?

• unusually tired/weak

SKIN review of systems

noticed any skin changes?

HEAD AND EYES review of systems

• headaches or dizziness

• vision changes

EARS, NOSE, THROAT review of systems

• hearing loss

• ear pain

• nasal congestion, nosebleeds

RESPIRATORY review of systems

• coughing?

• wheezing?

CARDIOVASCULAR review of systems

• chest pain?

• palpations?

• racing heartbeat?

PERIPHERAL VASCULAR review of systems

• swelling in legs or feet?

• numbness or tingling in legs or feet?

BREAST/AXILLA review of systems

• any lumps or pain in the breasts?

• any discharge from the breasts?

MSK review of systems

• any muscle or joint pain?

• any stiffness or swelling?

GASTROINTESTINAL review of systems

• abdominal pain?

• bloating?

• appetite changes?

URINARY review of systems

• colour of urine?

• blood in urine?

• regular periods?

SEXUAL HEALTH review of systems

• are you sexually active?

• any concerns surrounding your sexual health?

GENITAL SYSTEM review of systems

• pain, itching, discharge in genital area?

• lumps or swelling in genital area?

ENDOCRINE review of systems

• excessive sweating, thirst, urination?

• heat/cold intolerances?

HEMATOLOGICAL review of systems

• do you seem to bruise easily?

• any issues with bleeding?

functional health assessment

1. their health perception

2. nutrition

3. exercise

4. elimination

5. sleep and rest

6. self-perception/self-esteem

7. stress and coping

8. roles and relationships

9. values and beliefs

wrap up questions

• smoking

• alcohol

• substance use

• environmental and occupational hazards