For no pain:

Patient’s Name:
C.C.
BP:            HR:            RR:            Temp:

History present illness (HPI)

DOC PA FAA

         D          Describe what happened?
         O          Onset
         C          Constant/intermittent



         P          Precipitating event
         A          Alleviating factors



         F          Frequency
         A          Aggravating factors



         A          Associated symptoms

Review of systems (ROS)

THEN FR CS PUB SAWED

         T          Travel
         H          Headache
         E          Eye/visual/ Edema
         N          Nausea and vomiting

         F          Fever
         R          Racing heart/ Rash

         C          Chest pain/ Cough
         S          Shortness of breath

         P          Pain anywhere else
         U          Urinary problem
         B          Bowel movement

         S          Sleep
         A          Appetitie
         W          Weight/ Weakness/ tingling. numbness
         E          Exercise
         D          Dizziness

Past medical history (PMH)

PAM HITS FOS SAW

         P          Past medical history
         A          Allergies
         M          Medication

         H          Hospitalization in the past
         I          I’ll contacts
         T          Trauma
         S          Surgery

         F          Family Hx
         O          Ob/GYN(LMP RTV CS PAP)
         S          Sexual Hx

         S          Smoking/ recreational drug
         A          Alcohol (ask CAGE)
         W          Work

Differential diagnosis (DDX)

         1.
         2.
         3.
         4.