Pediatrics

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

Past medical history (PMH)

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

FEVER CUD SAD

         F          Fever
         E          Ear pulling
         V          Vomiting
         E          Eyes/ Ear discharge
         R          Rash / Rhinorrhea
         C          Cry / Chest symptoms/cough
         U          Urination (#dippers, order, color)
         D          Diarrhea (what color, blood, odor)

         S          Sleep/ Seizure (shaking)
         A          Activity (awake, playful)

         D          Dehydration (dry mouth, shrunken eyes)

Past medical history (PMH)

PAM IF BIG DEALS

         P          Past Medical History
                  * Past Surgical History
                  * Previous hospitalization
         A          Allergies
         M          Medications

         I          Ill contacts
         F          Family Hx

         B          Birth Hx
         I          Immunization
                  Growth & Development

         D          Day care (Sick contacts?)
         E          Eating habits
         A          Appetite
         L          Last Check up
         S          Sleep

Differential diagnosis (DDX)

         1.
         2.
         3.
         4.