Patient History OLDCAARTS O: onset L: location D: duration C: character A: alleviating/aggravating factors A: associated R: radiating T: timing S: severity Past Medical History Medical Condition: Hospitalization: ER visit: Health Maintenance (ex: immunization, pap smear, colonoscopy etc..) Surgery: Allergy: Medication (include supplements like vitamins): Family History Social History Living condition Work: Alcohol Drinks: Tobacco use: Exercise: Diet: Sexual History: Domestic violence: Spirituality: Review Of Systems (ROS) General: weight loss/gain, appetite Skin: lumps, rashes HEENT: vision changes, hearing changes Neck: pain, swelling Breasts: lumps, pain Respiratory: cough, shortness of breath Cardiovascular: chest pain, heartburn Gastrointestinal: abdominal pain, vomiting Peripheral: pain, swollen legs Urinary: dysuria, urgency Genital: pain, discharge Musculoskeletal: weakness, joint pain Psychiatric: depression, anxiety Neurologic: numbness, tremors Hematologic: Bruising, fever Endocrine: polyuria, heat/cold intolerance

Patient History

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