For any pain:

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

History present illness (HPI)

 

OS PDF LIQRAA+-

         O          Onset
         S          Self think

         P          Progression
         D          Duration
         F          Frequency

         L          Location
         I          Intensity
         Q          Quality
         R          Radiation
         A          Association
         +          Alleviated
         –          Aggravated

Review of systems (ROS)

JUST FOR CHECKLIST

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.
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         4.