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1.
Present complaints. You
should furnish all the main problems you have at present with their duration. In
case of certain complaints which are not permanent and occur occasionally, you should
mention details of their origin. Is it related to place, diet, food, occupation etc. ? Try
to provide maximum details about the symptoms.
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2. History of present
complaints.
You should give
all the details about the history of the present complaint. The mode of onset of symptoms
and the factors relieving the symptoms (eg: Rest, exercise, season, place,medication etc)
should be submitted here.
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3.
History of past illness. Furnish the details regarding the previous illnesses you
have suffered from (eg.viral infections, injuries, systemic diseases) along with the age
of onset, duration, outcome & residue.
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4.
Treatment history. Mention
the diagnosis if already known.Describe the treatments you underwent and medicaments /
therapies you are undergoing now. You should describe the order of use of the
medicines and the response to the treatment.
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5.Gynaecological
History. Please cover the following points in your information.
Age of menarche.
Whether the cycle is regular or irregular and the duration
Is the menstrual flow normal,scanty or excess.
Are you taking any contraceptive pills.
Age of menopause
Whether menstruation is associated with any discomforts like pain,vomiting, giddiness etc.
Any abnormal discharge eg.leucorrhoea-Give details
Details of pregnancies & type of delivery.
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6.
Personal history
a. Atmosphere at the job, family or the society.
Does your disease or symptoms have any relation to the above?Give details.
b. Bowel habits.
Time of the day when you usually go for bowel
movements.
Frequency
Colour of stool
Consistency
Whether foul smelling
Regular or irregular ? associated with pain, burning sensation or
itching ? any protrusion ?, blood spots or bleeding?
c.Allergy
Towards particular food, medicines, dust, climate
or others
d.
Influence of climate or environment.
Describe
briefly the type of climate and environment in which you live ? Is there any relationship
to the climatic condition? Do these symptoms increase or decrease in a particular climate
or environment ?
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7. Any
other information that you feel might help in making a proper diagnosis.
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8.
Reports of any other clinical investigations. You may fill detailed reports into our ready
formats which will load onto the screen when you press the submit key at the end of this
page ,
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